Utilization Management RN - Case Coordination & Care Planning

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 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.