Utilization Management Nurse RN

Signature HealthCARE is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions. We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as U.S. News & World Report, we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry.

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.

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.