IntusCare
Healthcare
UtilizationManagementNurse
“Utilization Management Nurse at IntusCare. Skills: Utilization management, Care coordination, Risk adjustment, Population health. Review service utilization. Guide care decisions”
What You'll Achieve.
Deliver exceptional care; Strengthen financial performance; Stay compliant; Improve outcomes for dual-eligible seniors; Ensure high-quality, cost-effective, and compliant care; Driving efficient and timely transitions of care; Driving efficient and timely discharge plans and transitions of care; Assuring consistency with Interdisciplinary Team service authorization, care plans, and PCP coordination decisions; Ensure issuance of a written determination consistent with the PACE program policies
Industry & Context.
Problem solving
What They're Looking For.
Must Have
Current RN license, 3 to 5 years of utilization management experience
Nice to Have
Proven experience working in risk based integrated models of care, Ability to use data to drive decisions and collaboration with internal and external stakeholders
What You'll Do.
Review service utilization
appropriate transitions across care settings
Ensure services are medically necessary
Ensure services are aligned with care plans
Ensure services are consistent with PACE regulations and best practices
Maintain program integrity
Improve participant outcomes
Support the delivery of coordinated
Adherence to PACE program service authorization policies
Concurrent review of all hospital admissions
Retrospective review of inpatient admissions under 48 hours
Review of all subacute and SNF admissions
Coordination and review of all other services delivered by contracted providers
Advocate quality care and enhanced quality of life
Advocate decreased hospital stay when appropriate
Maintain accurate records of all patient related interactions
Lead the provider appeals process
How You'll Work.
Team & Collaboration
Partner closely with PACE Interdisciplinary Teams, Medical Directors, and provider networks; Collaboration with internal and external stakeholders; Collaboration with the PACE Program's Medical Director
Communication Scope
Excellent communication
Applying for this Utilization Management Nurse role?
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