Utilization Management Nurse RN

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

Benefits offered by this job

Medical, Dental and Vision

Telemedicine

401(K) & Roth 401(K)

Tuition reimbursement

PTO

Employee discounts

Job summary

Signature HealthCARE in Louisville, KY is seeking an experienced Registered Nurse with a strong background in case management. You will collaborate with hospital, SNF and rehab teams, assess resident care needs, coordinate with MCOs, and ensure accurate billing and documentation using Case Management software.

Requires an active RN license, an Associate degree, and three years of hospital/SNF/acute rehab clinical experience.

Qualifications

• Active RN license in good standing.
• Associate degree required; Bachelor's degree preferred.
• Minimum of three (3) years hospital, SNF or Acute Rehab clinical experience.
• Knowledge of Medicare payment methodology and the MDS RUG system.
• Certification in Case Management through ACMA, CCMC or other credentialed agencies preferred or willingness to obtain after one year.

Responsibilities

• Collaborate regularly 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 baseline assessment of resident care needs and communicate effectively to the MCO ensuring all aspects of care services are communicated accurately.
• Verify all care needs and the authorization for services and outliers.
• Communicate with the MCO at required intervals as determined by the MCO.

Skills

RN license

Case management

Clinical experience

Communication

Education

Associate degree

Bachelor's degree preferred

Tools

Case Management software

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.