MANAGER - UTILIZATION REVIEW - CARE MANAGEMENT - SINAI
Company: LifeBridge Health
Location: Baltimore
Posted on: May 28, 2023
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Job Description:
Position Summary:
Responsible for the operational oversight related to utilization
management, utilization review, and denial management for all
commercial and government payers. Implements program to ensure
reimbursement for services is secured as it relates to medical
necessity and regulatory mandates for billing.
Provides operational direction, supervision, and oversight for
staff performing utilization management, utilization review, and
denial management functions for Sinai Hospital.
Ensures program support the reimbursement from commercial and
government payers for clinical services provided at Sinai
Hospital.
Assists the AVP of Care Management and Utilization Review in
developing and maintaining effective utilization management
programs within the context of the current healthcare
landscape.
Identifies and shares trends related to compliance with appropriate
status, medical necessity, appropriate utilization, and
denials.
Engages with internal and external partners to support the outcome
metrics for LBH Sinai Hospital strategies related to cost of care
and quality.
Qualifications/Requirements:
Basic professional knowledge; equivalent to a Bachelor's degree
Working knowledge of theory and practice within a specialized
field
Nursing, Bachelor of Science (BSN) required
3-5 years of experience
Maryland Registered Nurse License
American Heart Association CPR Certification
Prior experience as acute care case manager and/or hospital
discharge planner required, working knowledge of medical necessity
criteria in neonatal, pediatric, and adult population preferred.
Willingness to attain Certified Case Manager or Accredited Case
Manager credential within three years
Keywords: LifeBridge Health, Baltimore , MANAGER - UTILIZATION REVIEW - CARE MANAGEMENT - SINAI, Executive , Baltimore, Maryland
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