Utilization Management Nurse RN

Signature HealthCARE is a family-based healthcare company that offers integrated services in 5 states across the continuum of care: skilled nursing, rehabilitation, assisted living, memory care, home health, cognitive care, and telemedicine. A growing number of our centers are earning quality assurance accreditation and pioneering person - directed care. Many of our skilled nursing facilities have achieved a 4 or 5-star overall rating from the Centers for Medicare & Medicaid Services. Additionally, we have been awarded as a certified Great Place to Work for three years in a row and Modern Healthcare’s "Best Places to Work!"

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.