Top 21 Utilization management Jobs in Gulfport Ms

Utilization Management Manager-Utilization Mgmt- Days - FT
Memorial Hospital at Gulfport —Gulfport, MS
- Full-time
- Nursing
- RN License
- Bachelor of Science
Patient Care Specialist (Medical Receptionist)-Float
Fast Pace Health —Biloxi, MS
- Full-time
- CPR Certification
- Microsoft Outlook
- Computer literacy
- Paid holidays
- Health insurance
RN Case Manager
Ochsner Health System —Bay Saint Louis, MS
- Weekends as needed
- Nursing
- RN License
- Hospital
7d
Licensed Clinical Social Worker
Battelle —Stennis Space Center, MS
- Full-time
- Hybrid work
- Master of Social Work
- 5 years
- BLS Certification
- Wellness program
- Health insurance
Manager, Professional Development (RN) - Professional Development - Days - FT
Memorial Hospital at Gulfport —Gulfport, MS
- Full-time
- Nursing
- Heavy lifting
- RN License
Clinical Operations EMR Consultant
Maxwell TEC —United States
- $55 - $85 an hour
- Part-time
- Remote
- RN License
- Mid-level
- Home Health
Quick Apply
Physician ED Claims Reviewer
Vytwo —United States
- Full-time
- Remote
- Mid-level
- 2 years
Quick Apply

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Utilization Management Manager-Utilization Mgmt- Days - FT
Memorial Hospital at Gulfport —Gulfport, MS
Bachelor of Science in Nursing, with an active unrestricted license. Nursing degree (RN, BS, BSN, or advanced degree) and unrestricted active nursing license.
RN Case Manager
Ochsner Health System —Bay Saint Louis, MS
Required - Current registered nurse license in state of practice. Collaborates with the care team to develop and implement discharge plans based on patient’s…
7d

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Utilization Management Specialist
ST VINCENT FAMILY SERVICES —Columbus, OH
Associate's Degree required; Bachelor's Degree preferred in Healthcare Administration, Business Administration, Social Work, Public Health, or related field.
Quick Apply
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Conducts utilization reviews of behavioral health cases to determine medical necessity…

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Utilization Management Manager-Utilization Mgmt- Days - FT

Memorial Hospital at Gulfport -
Gulfport, MS

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Job Details

Full-time

Qualifications

RN License
Bachelor of Science in Nursing
Data-driven problem-solving
Bachelor's degree in nursing

Full Job Description

Oversee the management of patient care utilization, ensuring appropriate healthcare services are provided while optimizing resource use. This individual will be responsible for leading a team of nurses who review medical necessity, appropriateness and efficiency of healthcare services. Ensure compliance with regulatory requirements and maintain high standards of care.

Supervise and lead the UM nursing team and Pre-Certification Specialists, ensuring the review of patient cases for appropriate medical necessity and care protocols
Develop, implement and maintain UM policies and procedures in accordance with healthcare regulation and organizational standards
Conduct regular training and provide ongoing support for UR team to improve knowledge and performance
Collaborate with physicians, other healthcare providers and insurance companies to review and improve treatment plans. Ensure all services are medically necessary and cost effective
Evaluate and analyze healthcare utilization trends, identify opportunities for improvement and solutions to improve outcome
Monitor and ensure compliance with regulatory requirements including Medicare, Medicaid and other payer policies
Prepare and present reports on utilization metrics, case reviews and outcomes to administration leadership groups
Resolve complex case issues and provide guidance on challenging utilization decisions
Ensure accurate documentation of all UM reviews, ensuring compliance with internal and external audit
Foster effective communication between departments, stakeholders and healthcare professionals

Education Requirements

Required: Bachelor Degree

Bachelor of Science in Nursing, with an active unrestricted license

Preferred: Master's Degree

Nursing or other clinical discipline, Health Administration, Finance, Business Administration, or a related field

License or Certification Requirements

Required: License

Nursing degree (RN, BS, BSN, or advanced degree) and unrestricted active nursing license

Experience Requirements

Required: 5 years

Nursing experience with at least 2 years in Utilization Management or case management role

Preferred: 2 years

Leadership or management experience in nursing or related field

Core Competencies

Knowledge:

In depth knowledge of healthcare utilization management processes, medical terminology and clinical guidelines
Familiarity with payer requirements and regulation including Medicare, Medicaid and private insurers
Working knowledge of applications that are used to enhance utilization management based on evidenced based approach and guidelines
Strong knowledge of Microsoft Office applications

Skills:

Analytical Skills: The ability to analyze large data sets, determine trends, synthesize results, and deliver prioritized details through effective reporting
Communication Skills: Strong communication and interpersonal skills for effective collaboration and education
Problem-Solving Skills: The capacity to understand issues, derive many potential solutions, troubleshoot discrepancies, and understand systematic approaches to problem resolution

Abilities:

Attention to Detail: Precision is essential when reporting critical analysis to inform decision-making and operational change
Time Management: Managing multiple tasks and deadlines while prioritizing work is essential in a fast-paced healthcare environment
Technology Proficiency: Beyond EHR systems, familiarity with various billing software and technology tools

Work Environment: This position may involve working in a variety of clinical and administrative settings, requiring adaptability and a proactive approach to problem-solving.

Physical Demands: Frequent reaching, sitting, walking, and standing may be required. No special coordination beyond that used for normal mobility and handling of everyday objects and materials is needed to perform the job.

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utilization management jobs in gulfport ms

Utilization Management Manager-Utilization Mgmt- Days - FT

Patient Care Specialist (Medical Receptionist)-Float

RN Case Manager

Licensed Clinical Social Worker

Manager, Professional Development (RN) - Professional Development - Days - FT

Clinical Operations EMR Consultant

Physician ED Claims Reviewer

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