Utilization Management Behavioral Health
Kiosk mode
R-0000062309
Remote
South Carolina
Healthcare Support
Clinical & Research Support Services
Full Time
Hospital Authority (MUHA)
About the role
Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Reviews treatment plans and status of approvals from insurers. Collects and compliles data as required and according to applicable policies and regulations. Consults with physicians as needed.
Responsibilities
- Conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition.
- Makes sure patient charts and records are evaluated for care during their treatment.
- Reviews treatment plans and checks the status of insurance approvals.
- Collects and organizes data as needed, following relevant policies and regulations.
- Consults with physicians as necessary.
Requirements
- Bachelor's degree in Nursing from an accredited school of nursing and three years' work experience as a Registered Nurse required.
- Prior leadership experience preferred.
- One year of case management and/or utilization management work experience preferred.
- Staff hired prior to July 1, 2013 will be grandfathered in regarding the education requirement.
- Must possess excellent verbal and written communication skills.
- Familiarity with InterQual or Milliman and Robinson screening criteria is desired.
- Licensure as a registered nurse by the state of South Carolina or a compact state is required.
Qualifications
- Bachelor's degree in Nursing from an accredited school of nursing and three years' work experience as a Registered Nurse required.
- Prior leadership experience preferred.
- One year of case management and/or utilization management work experience preferred.
- Staff hired prior to July 1, 2013 will be grandfathered in regarding the education requirement.
- Must possess excellent verbal and written communication skills.
- Familiarity with InterQual or Milliman and Robinson screening criteria is desired.
- Licensure as a registered nurse by the state of South Carolina or a compact state is required.
Skills
- Excellent verbal and written communication skills.
- Familiarity with InterQual or Milliman and Robinson screening criteria.
- Licensure as a registered nurse by the state of South Carolina or a compact state.
Benefits
Not specified
Pay
Salary
Schedule
Full Time
Physical Requirements
- Mobility & Posture:
- Standing: Continuous
- Sitting: Continuous
- Walking: Continuous
- Climbing stairs: Infrequent
- Working indoors: Continuous
- Working outdoors (temperature extremes): Infrequent
- Working from elevated areas: Frequent
- Kneeling: Infrequent
- Bending at the waist: Continuous
- Twisting at the waist: Frequent
- Squatting: Frequent
- Physical Demands:
- Pinching operations: Frequent
- Gross motor use (fingers/hands): Continuous
- Firm grasping (fingers/hands): Continuous
- Fine manipulation (fingers/hands): Continuous
- Reaching overhead: Frequent
- Reaching in all directions: Continuous
- Repetitive motion (hands/wrists/elbows/shoulders): Continuous
- Full use of both legs: Continuous
- Balance & coordination (lower extremities): Frequent
- Lifting & Force Requirements:
- Lift/carry 50 lbs. unassisted: Infrequent
- Lift/lower 50 lbs. from floor to 36”: Infrequent
- Lift up to 25 lbs. overhead: Infrequent
- Exert up to 50 lbs. of force: Frequent
- Examples:
- Transfer 100 lb. non-ambulatory patient = 50 lbs. force
- Push 400 lb. patient in wheelchair on carpet = 20 lbs. force
- Push patient stretcher one-handed = 25 lbs. force
- Vision & Sensory:
- Maintain corrected vision 20/40 (one or both eyes): Continuous
- Recognize objects (near/far): Continuous
- Color discrimination: Continuous
- Depth perception: Continuous
- Peripheral vision: Continuous
- Hearing acuity (with correction): Continuous
- Tactile sensory function: Continuous
- Gross motor with fine motor coordination: Continuous
- Selected Positions:
- Olfactory (smell) function: Continuous
- Respirator use qualification: Continuous
- Work Environment & Conditions:
- Effective stress management: Continuous
- Rotating shifts: Frequent
- Overtime as required: Frequent
- Latex-safe environment: Continuous
Additional Information
If you like working with energetic enthusiastic individuals, you will enjoy your career with us!
The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify
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