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Inside Higher Ed · 22 hours ago

Utilization Management Reviewer/UKHC

Lexington, KY

Full-time

Hybrid

Mid, Senior Level

$54K/yr - $95K/yr

5+ years exp

Inside Higher Ed is seeking a Utilization Management Reviewer to work as a member of a multidisciplinary team. The role involves managing and coordinating functions related to third party payer certification and utilization of health services.

Digital MediaEducationHigher EducationJournalismRecruiting

Responsibilities

Actively manage and coordinate those functions associated with third party payer certification

Appropriate utilization of health services

Some aspects of discharge planning

Qualification

Registered Nurse (RN)Utilization management knowledgeMedicare/Medicaid knowledgeThird party payer knowledgeInterpersonal skillsLeadership skillsOrganizational skillsWritten/verbal 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