"Alerted.org

+ Remote: Yes

+ Area of Interest: Nursing

+ Salary Range: $35.18-$52.78/hr*

+ FTE/Hours per pay period: 1.0

+ Department: Prec Carve Out

+ Shift: Monday-Friday; 8:00am-5:00pm

+ Job ID: 158321

Overview

Shift: Monday-Friday; 8:00 AM - 5:00 PM

We are seeking a dedicated professional to join our care team and play a vital role in coordinating patient services. In this role, you will collaborate with interdisciplinary teams to ensure patients receive the right care at the right time. You’ll be responsible for managing utilization by overseeing payment authorizations, clinical coordination, and discharge planning. Additionally, you’ll support patients by monitoring care plans, addressing individual needs, and facilitating access to community resources to promote continuity of care.

Why UnityPoint Health?

At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.

Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.   Here are just a few:

+ Expect paid time off, parental leave, 401K matching and an employee recognition program .

+ Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.

+ Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family .

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.

And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.

Find a fulfilling career and make a difference with UnityPoint Health.

Responsibilities

+ Performs utilization and case management reviews using established criteria to confirm medical necessity, appropriate level of care and efficient use of resources and payment approval.

+ Requests reviews with physician advisors, and/or Executive Health Resources (EHR), as appropriate, if admission or continued stay criteria are not met, assuring appropriate and timely level of care status.

+ Conducts payment authorizations and coordinated payment denials while meeting timeliness guidelines.

+ Ensures case coordination with client’s health care providers.

+ Provides utilization management and case management to designated enrollees. Assuring that all enrollees receive clinically sound triage/referral and ongoing care management services for medical needs.

Qualifications

Education:

+ Registered Nurse

+ CCM (Certified Case Manager)

License(s)/Certification(s):

+ Compact Nursing License / or licensed behavioral health clinician. Required Illinois and Iowa licenses within first 90 days of hire.

Experience:

+ 5+ years of nursing experience

+ Insurance experience on the company side is required.

*Specific offers are determined by various factors , such as experience, skills, internal equity, and other business needs. T he salary range listed does not include other forms of compensation which may include bonuses/incentive, differential pay, or other forms of compensation or benefits that may be applicable to this role.

#RYCJessi