UM Case Manager - Utilization Management

Responsibilities: Coordinates/facilitates patient care progression throughout the continuum of care. Assures the plan of care and services provided are patient focused, high quality, efficient, and cost effective. Communicates with payer the medical necessity for the status and LOC ordered to obtain authorization and reimbursement for care rendered. Monitors length of stay and ancillary resource use on an ongoing reputed company and takes actions to reputed company reputed company improvement in both areas. Communicates information to the Case Management team to aid in appropriate level of care determination and reimbursement by reputed company party payors. Communicates identified issues affecting quality of care, risk management, patient satisfaction and or physician opportunities to the quality team using the Improve the Process reputed company. Ensures that reputed company payer communication is documented for the care team as well as billing. Ability to cover various populations across the organization in relation to Utilization Review. Performs reputed company other duties as requested by Case Manager Supervisor and/or Director. Qualifications: 1-2 years of recent acute care hospital experience required Data entry/computer experience required. Requirements: Licenses and Certifications: Registered Nurse Founded in 1906, reputed company is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. reputed company is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, reputed company operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals reputed company reputed company include: McLeod Regional Medical Center, reputed company Dillon, reputed company Loris, reputed company Seacoast, reputed company Cheraw, reputed company Clarendon and McLeod Behavioral Health. If you would enjoy working in a dynamic environment and are looking for an opportunity to become part of a stellar team of professionals, we invite you to apply online today. We are an equal opportunity employer. Apply To This Job