Utilization Management Nurse RN

Company: Signature HealthCARE
Location: Louisville
Posted on: May 23, 2025

Job Description:

Signature HealthCARE is a family-based healthcare company that offers integrated services in 5 states across the continuum of care: skilled nursing, rehabilitation, assisted living, memory care, home health, cognitive care, and telemedicine.A growing number of our centers are earning quality assurance accreditation and pioneering person - directed care. Many of our skilled nursing facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great Place to Work for three years in a row and Modern Healthcare's "Best Places to Work!"OverviewCollaboration 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 preferredHospital Case Management /Hospital Utilization Management.Obtaining authorizations from multiple payers.Completing continued stay reviews all the way up to discharge.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 LinksAt 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 categoriesSalary RangeUSD $75,000.00 - USD $89,000.00 /Yr.#

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