Signature Healthcare Home Office
Signature Healthcare Home Office
Lexington, KY, US,
For additional information, please contact:
Hillary Bayens, SR Director of Talent Acquisition
How you will make a difference:
· Collaboration with Managed Care Organizations (MCO) and care providers is vital to ensure care is being delivered in the right setting at the right time.
How you will spend your time:
* Meet the physical and sensory requirements stated below and be able to work in the described environment.
* Identify and participate in process improvement initiatives that improve the customer experience, enhance work flow, and/or improve the work environment.
* Collaborate regularly and maintain open communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses.
* Coordinate internal and external health care team activities related to resident care, transitions and discharge planning with agencies, and other healthcare organizations.
* Conduct initial baseline assessment of resident care needs and communicate that effectively to the Managed Care Organization (MCO) ensuring all aspects of care services are communicated accurately.
* Verify all care needs and the authorization for services and outliers.
* Communicate/collaborate with the Managed Care Organization (MCO) at required intervals as determined by the MCO
* Negotiate appropriate levels based on services provided and contractual arrangements with the facility and the MCO.
* Document all authorizations and continued stay activity in Case Management software to ensure appropriate reporting and billing.
* Prepare all Managed Care documentation to facility accurate billing.
* Promote effective and efficient use of resources.
* Serve as a liaison between the MCO and the skilled facility, ensuring all regulatory requirements are met in a timely manner.
* Ensure that resident tests and procedures are appropriate, necessary, carried out within an established timeframe and reported promptly to the MCO.
* Initiate and obtain authorization for identified referrals as necessary.
* Participate in all care meetings, (telephonically) associated with the MCO population to ensure appropriate billing.
* Other special projects and duties, as assigned.
The qualifications you will need:
* Registered Nurse (RN) or Licensed Practical Nurse (LPN) in current state with no disciplinary action, compact license preferred.
* Associates degree in nursing acceptable, Bachelor’s degree preferred. LPN will be considered with previous utilization review experience.
* Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual.
* Minimum of three (3) years related case management experience, utilization review experience preferred.
* Minimum of three (3) years prior clinical experience preferably in an acute care, skilled, or rehabilitation clinical setting.
* Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
* Certification in Case Management through ACMA, CCMC or other credentialed agencies, preferred or willing to obtain after one year of employment.
* Knowledge of Medicare payment methodology. Previous experience with MDS and assessment preferred.
* Ability to navigate multiple electronic healthcare systems to retrieve and communicate data to the MCO.
* Strong written and verbal communication skills.
* Highest level of professionalism with the ability to maintain confidentiality.
* Ability to communicate at all levels of organization and work well within a team environment in support of company objectives.
* Customer service oriented with the ability to work well under pressure.
* Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.
* Strong analytical and problem solving skills.
* Ability to work with minimal supervision, take initiative and make independent decisions.
* Ability to deal with new tasks without the benefit of written procedures.
* Approachable, flexible and adaptable to change.
* Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors.
SignatureHealthcare is an Equal Opportunity-Affirmative Action Employer – Minority / Female / Disability / Veteran and other protected categories.: