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UK HealthCare · 1 day ago

Utilization Management Reviewer/UKHC

Greater Lexington Area

Full-time

Hybrid

Mid, Senior Level

$54K/yr - $95K/yr

5+ years exp

UK HealthCare is seeking a Utilization Management Reviewer to work as part of a multidisciplinary team. The role involves managing and coordinating functions related to third party payer certification and the appropriate utilization of health services.

Health CareHealth DiagnosticsHospitalMedical

Responsibilities

This position works as a member of the multidisciplinary team with social workers, patient care facilitators, financial counselors, and ancillary staff to actively manage and coordinate those functions associated with third party payer certification, appropriate utilization of health services, and some aspects of discharge planning

Qualification

Registered Nurse (RN)Utilization managementMedicare knowledgeMedicaid knowledgeInterpersonal skillsLeadership skillsOrganizational skillsWritten communicationVerbal communication

Required

ADN

5 yrs

Registered Nurse (RN)

The physical conditions of this position include; regularly sitting at a computer workstation for extended periods of time with repetitive motions (such as typing); occasionally lifting, pushing, and/or pulling objects up to 10lbs

strong interpersonal, leadership, organizational, and written/verbal communication skills

General knowledge of criteria for accessing appropriate utilization of resources in the hospital

Exceptional planning and organizational skill

Effective written and verbal communication skills

General knowledge of criteria utilized by third party payers for admission and continued stay authorizations

General knowledge of Medicare, Medicaid, and third party payer reimbursement issues