CASE MANAGER FT - Utilization Review (13993)

Cullman Regional Medical Center, Inc.; Cullman (AL); On-site; USD 70,000 - 95,000; Full time

Job summary

Cullman Regional Medical Center in Cullman, AL is seeking a Full-Time Case Manager - Utilization Review to coordinate with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost-effective care. You will support physician provision of patient care with accountability for a designated case load.

Responsibilities include facilitating precertification and payor authorization, leading multidisciplinary collaboration, applying evidence-based

Qualifications

• Requires nursing degree and active Alabama license.
• BSN preferred.
• Excellent communication and interpersonal abilities; proficient with CMS guidelines and payor portals.

Responsibilities

• Coordinate with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost-effective care.
• Support physician provision of patient care with accountability for designated patient case load.
• Facilitate precertification and payor authorization processes and collaborate across the care continuum.

Skills

Advanced communication

Interpersonal skills

CMS guidelines familiarity

Education

Associate's degree in nursing or higher

BSN preferred

Tools

Microsoft Word

Excel

Job description

# CASE MANAGER FT - Utilization Review (13993)Cullman Regional Medical Center - Cullman, AL 35056## OverviewPosition TypeFull TimeJob ShiftAnyCategoryNurse## Description**Job Summary:*** Coordinate with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost-effective care.* Support physician provision of patient care with accountability for designated patient case load.* Facilitate precertification and payor authorization processes and facilitate collaborative management of patient care across the continuum, intervening as necessary.* Promote effective utilization and monitoring of healthcare resources and assumes a leadership role with the multidisciplinary team to achieve optimal clinical and resource outcomes.* Apply process improvement methodologies in evaluating outcomes of care.* Maintain and ensure adherence to clinical guidelines, tools and protocols based on evidence-based medicine related to quality measure indicators.* Assume leadership role in coordinating quality improvement activities related to quality measure initiatives.* Demonstrate and encourage team behavior and exceptional patient/guest experiences.* Uphold and promote patient safety and quality.## Qualifications**Education:** Associate's degree in nursing or higher degree is required. Currently licensed by the state of Alabama. BSN preferred.**Experience:** Five years' clinical experience in acute care setting i.e., medical surgery, ICU, ER, OR required. Previous Utillization Review experience is preferred.**Additional Skills/Abilities:** Skill and proficiency in applying highly technical principles, concepts and techniques that are central to case management. Advanced communication and interpersonal skills with all levels of internal and external customers. Must be proficient in Microsoft Word and Excel. Familiar with CMS Guidelines, navigating within payor portals, following up on pending approvals/denials. Excellent organizational skills are required. Must be able to set priorities appropriately and handle multiple issues concurrently.