Utilization & Review Care Manager

Location
Rockville, MD
Posted
Jul 25, 2018
Closes
Aug 25, 2018
Function
Management
Industry
Healthcare
Hours
Full Time
Behavioral Health&Wellness

If you are a current Adventist HealthCare employee, please click this link to apply through your Workday account. Qualifications:
Degree such as nursing, social work, psychology, health information management or other related healthcare field is preferred or related experience.
College level reading, writing and math with strong verbal skills.
Basic PC skills (MS word, Excel and Access)
Understanding of managed care and ability to apply and interpret behavioral health care service delivery.
Knowledge of medication and medical terminology.
Strong customer service skills.
Able to handle a multi-task environment and work independently with some supervision.

Responsibilities:
Responsible for reviewing medical records for clinical criteria, appropriate level of care and compliance with standards.
Assures compliance with standards; ie. JCAHO, COMAR, HIPAA, Federal and State Regulations.
Conducts pre-authorization as needed; performs concurrent and continued stay reviews.
Obtains authorization for all related services; ie. psychological, medical, chemical dependency and other levels of care.
Prepares and submits medical record for appeal.
Assists the treatment team with information related to discharge planning and obtains authorization as needed.
Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients.
Work Schedule:


Day



Tobacco Statement


Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine use.


Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine). Those testing positive for cotinine are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.



Equal Employment Opportunity


Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.


Similar jobs

More searches like this