Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)
Jai Medical Systems Managed Care Organization, Inc. was founded in 1997 and serves a diverse population of children and adults throughout the State of Maryland.
Since our founding, Jai Medical Systems’ mission has been to provide high quality healthcare benefits and services to the people of Maryland. We continue this tradition of quality and excellence by working with our members to help identify their healthcare needs, while remaining an active and positive presence within our communities.
Case Management/Utilization Review Nurse (RN) Position Overview:
We are currently seeking a full-time, licensed registered nurse for case management and utilization review. Prior CM/UR nursing experience preferred, but not necessary.
Case Management/Utilization Review RN will perform telephonic reviews for enrollees across the service continuum (pre-certification/authorization, concurrent and retrospective reviews) utilizing InterQual criteria to monitor providers to ensure the quality, quantity, timeliness and effectiveness of service. RN will perform case management/complex case management on identified members in order to increase compliance and help with coordination of care.
Case Management/Utilization Review Nurse (RN) Requirements:
Job Type: Full-time
Pay: From $76,000.00 per year
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Work Location: In person