Job Information
YesCare Corp Utilization Management Coordinator in Bartow, Florida
Experience & Requirements
Licensed Registered Professional Nurse currently registered to practice in state of facility.
Minimum of five (5) years prior hospital experience with five (5) years corrections experience
Minimum of two (2) years prior experience with UM preferred
Minimum of one (1) year prior experience with McKesson InterQual systems preferred
Previous training and demonstrated competence in Quality Assurance
Computer knowledge required
Maintains current BLS certification
A background check, security clearance and drug screening are required for this role.
YesCare is an Equal Opportunity/Affirmative Action Employer. In compliance with federal and state employment opportunity laws, qualified applicants are considered for all positions without regard to race, gender, national origin, religion, age, sexual orientation, disability, Vietnam era veteran, or disabled Veteran status. EOE including Disability/Protected Veterans.
Responsibilities
Below is a list of your responsibilities as a Utilization Management Coordinator with YesCare:
Confirms admissions with outside hospitals and notifies the Utilization Management Department of need to report justification for admission
Monitors hospitalized patient’s status and reports back to the Program Manager on site.
Provides daily inpatient reports to the HSA and HSS at each institution
Works with attending physician and the providers of the Utilization Management Department to arrange discharge plan
Coordinates with the hospital utilization nurse to expedite discharge and avoid excessive lengths of stay
Notifies appropriate personnel of any hospitalization longer than five (5) days
Responsible for ensuring the monthly report is sent to each site and participates in Utilization Review with Clinical Director and other personnel as required
Provides assistance in the development and implementation of Utilization Management Policies and Procedures
Assists in approval process of outside services
Assists in data entry
Communicates denial of inpatient charge to providers
Assists in negotiating charges and arrangements for outside services
Continually seeks inventive methods for reducing outside services costs
Reviews forms for completeness and accuracy
Serves as resource to sites and providers for authorization numbers
Forwards daily inpatient case management abstracts to Corporate UM
Reviews requests for outpatient services, codes, and forwards to Corporate UM Medical Director
Performs monthly audit of Inpatient, ER and Outpatient Events
Performs hospital review of complicated and extended stay cases
Provides in-servicing of staff on areas of expertise
Liaison between Corporate UM, institution physician and off-site hospital staff
Complies with all rules, directives, policies, procedures and protocols of client andYesCare
Assumes additional duties as necessary.
YesCare Benefits (only applicable for full-time positions)
Health, Dental and Vision Insurance
Life and Disability Insurance
Generous PTO plan
401k with matching funds
Employee Discount and Rewards Program
Tuition Assistance
Continuing Education Reimbursement
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About YesCare Health
Correctional healthcare is not just a job. It’s a calling.
By choosing a career with YesCare, you are choosing the opportunity to truly make a difference in the health, well-being, and future of the patients you serve. We take pride in being a pioneer provider of correctional healthcare. As a YesCare professional, you have access to the resources and support to enhance your skills, build a solid foundation to reach your career potential, and contribute to the care and well-being of an underserved population. There is no greater calling. Join YesCare today and be part of our legacy of innovation and clinical expertise.
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ID 2024-18851
Job Locations US-FL-Bartow
Category Healthcare Support
Position Type Regular Full-time
Location ID 00834