Utilization Management Nurse RN

Signature HealthCARE, LLC; Louisville (KY); On-site; USD 75,000 - 82,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) and Roth 401(k)

Tuition reimbursement

PTO and paid holidays

Telemedicine services

Job summary

Signature HealthCARE, LLC in Louisville, KY seeks an experienced RN Case Manager to coordinate care with Managed Care Organizations and internal teams. You will assess resident needs, authorize services, and ensure accurate reporting and billing.

A strong background in case management and Medicare/MDS is essential for success in this role. The position offers full-time hours, opportunities for professional growth, and a comprehensive benefits package.

Qualifications

• RN licensure required and in good standing.
• Associate degree in Nursing or higher required; Bachelor's preferred.

Responsibilities

• Collaborate with MCOs and care teams to ensure appropriate setting and timing of services.
• Assess resident care needs and communicate clearly to MCO; authorize services and address outliers.
• Coordinate discharge planning with agencies and health care organizations.
• Document authorizations and continued stay activity in Case Management software for billing.
• Prepare Managed Care documentation to ensure accurate facility billing.

Skills

RN licensure

Case management

Medicare/MDS knowledge

Hospital/SNF/Acute Rehab experience

Education

Nursing license (RN)

Associate degree in Nursing

Bachelor's degree preferred

Tools

Case Management software

MDS RUG system

Job description

Signature HealthCARE is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions.

We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as U.S. News & World Report, we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry.

Overview

Collaboration with Managed Care Organizations (MCO) and care providers is vital to ensure care is being delivered in the right setting at the right time.

How you Will make a difference

• Collaborate regularly and maintain open communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses.
• Coordinate internal and external health care team activities related to resident care, transitions and discharge planning with agencies, and other healthcare organizations.
• Conduct initial baseline assessment of resident care needs and communicate that effectively to the Managed Care Organization (MCO) ensuring all aspects of care services are communicated accurately.
• Verify all care needs and the authorization for services and outliers.
• Communicate/collaborate with the Managed Care Organization (MCO) at required intervals as determined by the MCO
• Negotiate appropriate levels based on services provided and contractual arrangements with the facility and the MCO.
• Document all authorizations and continued stay activity in Case Management software to ensure appropriate reporting and billing
• Prepare all Managed Care documentation to facility accurate billing.

What you Need to make a Difference

• Registered Nurse (RN) in good standing with required current state license.
• Associates degree required, but Bachelor's degree preferred.
• Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
• Minimum of three (3) years related case management experience.
• Minimum of three (3) years of hospital, SNF or Acute Rehab clinical experience
• Certified in Case Management through ACMA, CCMC or other credentialed agencies, preferred or willing to obtain after one year of employment.
• Knowledge of Medicare payment methodology and the MDS RUG system. Previous experience with MDS and assessment preferred

Our exceptional Benefits Package and Signature Perks include the following and more!

• Medical, Dental and Vision - Voluntary Life/Disability
• Free Telemedicine with Medical Plan
• 401(K) and Roth 401(K)
• Tuition Forgiveness/Education Reimbursement
• A variety of additional specialized Insurances
• Pay Advance and Next Day Pay!
• Paid Time Off (PTO)
• Partner Perks and Discounts!
• Reward & Recognition Program (HEART)
• Vital Links

At Signature HealthCARE, our team members are permitted - no, encouraged - to employ their talents and abilities to solve problems. Our culture is built on three distinct pillars: Learning, Spirituality and Intra-preneurship. Each pillar has its own staff and initiatives, ensuring that our unique culture permeates the entire organization. Come see what the revolution is all about!

Signature HealthCARE is an Equal Opportunity-Affirmative Action Employer - Minority / Female / Disability / Veteran and other protected categories

Salary Range

USD $75,000.00 - USD $82,000.00 /Yr.