Remote UM Specialist
About The Position
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Utilization Management Specialist - REMOTE. In this role, you will leverage your clinical expertise to significantly influence patient outcomes through effective utilization management practices. This position involves reviewing patient admissions and collaborating with multidisciplinary teams to ensure appropriate admission status. You will utilize your exceptional communication and analytical skills to navigate the complexities of health care support processes effectively. Join us in making a positive impact on health care delivery while working from the comfort of your home.
Requirements
- Current RN license in Montana or multi-state compact license.
- Bachelor's or Master's degree in Social Work or relevant field.
- Minimum five years of acute care hospital experience.
- Prior experience in inpatient utilization review preferred.
- Knowledge of Medicare and Medicaid regulations.
- Strong interpersonal communication and analytical skills.
- Detail-oriented with the ability to manage multiple priorities.
Nice To Haves
- Prior experience in inpatient utilization review preferred.
Responsibilities
- Review daily inpatient and observation admissions across the system.
- Evaluate physician documentation and patient data to determine admission status.
- Reassess patient care levels throughout their stay.
- Collaborate with interdisciplinary teams for authorizations and medical necessity reviews.
- Assist with scheduling peer-to-peer physician reviews.
- Communicate effectively with providers and stakeholders.
- Identify compliance or review delays and address them promptly.
- Utilize electronic medical records for documentation and reporting.
Benefits
- Four-day work week with flexible scheduling.
- Affordable medical benefits package.
- 401(k) with generous employer match.
- Discounted fitness center membership.
- Supportive and mission-driven work culture.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
