Utilization Management RN or Social Worker Per Diem

Trinity Health • Waterbury, CT

13d • Remote

About The Position

The Utilization Management Specialist is responsible for acute care concurrent review authorizations, denials tracking & reporting as well as appeals management. Acts as a resource and guide for physicians, the care delivery team, patients and their families throughout the continuum of available health care services by effectively monitoring, evaluating and integrating direct clinical and supportive services in order to achieve and maintain optimal patient health status and expectations. Ensures validity of accurate documentation of severity of illness (profiling) by working with the physician in the concurrent review process. May assist with patient care services care coordination, psychosocial groups and/or complete biopsychosocial.

Requirements

• Must be licensed RN or Social Worker in CT
• Master’s-level Licensed professional (LCSW, LMFT, LPC) or RN (Masters not required)
• State of Connecticut LCSW, LMFT, LPC or RN license in good standing required
• Minimum of one (1) year related mental health care experience
• Local residency required but may work from home

Responsibilities

• Provide assessment for all patients within Clinical Program to determine level of Case Management intervention
• Plan for high quality, realistic, and cost-effective/ resource driven continuum of care arrangements for identified patients
• Collaborate with physicians and appropriate members of the care team to plan, coordinate and revise the patient care plan as necessary
• Maintain communication with physicians and payers regarding situational comparison to criteria, plan of care and discharge plan
• Initiate/confirm admission authorization and certification for all days stayed
• Collaborate with other hospital departments, i.e. Finance, Hospital Information Management (Medical Records) and Admitting, to provide pertinent data relating to utilization management / clinical resource management issues and questions

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level