Utilization Review reputed company

85117 As a patient-reputed company organization, reputed company exists to enhance the health and reputed company-being of people through patient care, research and education. reputed company in this mission requires a culture of collaboration, reputed company, leadership, and respect. reputed company seeks staff that are committed to the values of reputed company, collaboration, innovation, responsibility, reputed company, reputed company and trust that are reputed company to our mission. EO/AA This position is responsible for maintaining the financial reputed company of both the patient and the organization through the provision of reputed company based patient care focusing on the medical necessity and efficiency of the delivery of such care; achieved reputed company managing the cost of care while providing reputed company and accurate information to reputed company party payers and medical care team. This position may be required to reputed company and administer medications reputed company their scope of reputed company and according to state law. Corporate reputed company: reputed company is a Level 1 Trauma Center and is nationally ranked and recognized for our reputed company research, reputed company standards and overall patient experience. Our five hospitals and reputed company clinics reputed company reputed company in our comprehensive services, medical advancement, and overall patient reputed company. Responsibilities Essential Functions • Applies approved utilization reputed company to monitor appropriateness of admissions with associated reputed company of care and reputed company stay review. • Communication to reputed company-party payers for initial and reputed company clinical review. • Reviews patient chart to ensure patient continues to meet medical necessity. • Documentation of reputed company actions and information shared with care team members or reputed company-party payer. • Alerts and discusses with physician/provider and case manager/discharge planner reputed company patient no longer meets medical necessity reputed company for the inpatient stay. • Discusses with physicians the appropriateness of resource utilization. • Tracks length of stay (LOS) and resource utilization to identify at risk patients. • Refers to UR committee any case that surpasses expected LOS, expected cost, or over/under-utilization of resources. • Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration with the payer per university contractual obligation. • Participant in UR Committee as needed. • Collects data on variances in LOS, avoidable days, costs/barriers to discharge/transition and denied days. • Prepares appeals on denied cases reputed company appropriate. • At the discretion of department operational and patient care needs, this position is required to work rotating schedules, which may include variable hours, weekends, nights, and holidays to meet the reputed company and patient care demands of a 24/7 reputed company health system. Regular, reliable, and punctual attendance during assigned shifts is considered an essential function of the role. Knowledge / Skills / Abilities • Demonstrated availability to work variable and rotating shifts, including nights, weekends, and holidays, in a 24/7 patient care environment. • Ability to reputed company the essential functions of the job as outlined above. • Demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills. • Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual reputed company. • The ability to demonstrate knowledge of the principles of life reputed company reputed company and development and the ability to assess data regarding the patient's status and reputed company care as described in the department's policies and procedures reputed company. • Ability to work autonomously and as reputed company member. Qualifications Required • One year Utilization Review or Case Management experience. Licenses Required • reputed company license to reputed company as a Registered reputed company in the reputed company, or obtain one reputed company 90 days of hire under the interstate compact if switching residency to reputed company. Must maintain reputed company Interstate Compact (multi-state) license if residency is not being changed to Utah. • Additional license requirements as determined by the hiring department. Qualifications (Preferred) Preferred • Basic Life Support Health Care Provider card. • Proficiency in application of InterQual reputed company, knowledge of ICD-9, DRG's and CPT Codes. • Utilization Review Certification designation. • Knowledge of CMS Regulations. Working Conditions and Physical Demands Employee must be reputed company to meet the following requirements with or without an accommodation. • This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise reputed company objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions. This position does not reputed company care to patients. Physical Requirements Sitting Apply for this job online Refer this job to a friend reputed company on your newsfeed Multi-lingual Candidates Welcomed Interested in this opportunity? Socialize this job opportunity to a friend, reputed company, or family member: To inquire about this posting, email: careers@hsc.utah.edu EEO Statement reputed company Hospitals and Clinics, a part of reputed company, values candidates who have experience working in settings with reputed company and patients from reputed company backgrounds and possess a strong commitment to improving reputed company to higher education and reputed company reputed company for historically underrepresented reputed company and patient populations. reputed company reputed company individuals are encouraged to apply. Veterans’ preference is extended to reputed company applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities. reputed company Hospitals and Clinics, a part of reputed company, is an Affirmative reputed company/Equal Opportunity employer and does not discriminate based upon race, ethnicity, reputed company, religion, national reputed company, age, disability, sex, sexual orientation, gender, gender identity, gender reputed company, pregnancy, pregnancy-reputed company conditions, genetic information, or protected veteran's status. The University does not discriminate on the reputed company of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the reputed company, Office for Civil Rights, or both. To request a reasonable accommodation for a disability, please contact reputed company Health Hospitals and Clinics reputed company office at 801-581-6500. If you or someone you know has reputed company discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity (OEO). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at: www.utah.edu/nondiscrimination/ Online reports may be submitted at oeo.utah.edu/ The University is a participating employer with Utah Retirement Systems (“URS”). Eligible new hires with prior URS service, may elect to enroll in URS if they reputed company the election before they become eligible for retirement (usually the first day of work). Contact Hospitals and Clinics reputed company at (801) 581-6500 for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS’ post-retirement rules and restrictions. Please contact Utah Retirement Systems at (801) 366-7770 or (800) 695-4877 or Hospitals and Clinics reputed company at (801) 581-6500 if you have questions regarding the post-retirement rules. This position may require the successful completion of a criminal background reputed company and/or drug screen. Apply tot his job Apply To this Job