UM Nurse Specialist
Company: YesCare Corporation
Location: Brentwood
Posted on: April 18, 2024
Job Description:
Experience & Requirements
- Experience Level: 3 - 5 year's experience in utilization
management, case management, quality management. Experience with
InterQual and/or Milliman Care guidelines preferred. Strong
organizational and time management skills.
- Tools and Technology: Computer usage for word processing,
spreadsheets, email, internet, medical records and other
proprietary company/client systems.
- Certificates and Licenses: Registered Nurse (RN) active
license
- Language Ability: Strong verbal, written communication skills.
Effectively present information in one-on-one and group situations
to nursing staff, clients and other employees of the
organization.
- Reasoning Ability: Ability to work on extremely complex
problems where analysis of situations or data requires an
evaluation of intangible variance factors.
- Work Environment: Office environment with occasional travel up
to 10% to regional offices, client and/or vendor sites. 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 Specialist 2 with
YesCare :
- Responsible for the implementation of a comprehensive
outpatient/inpatient review process utilizing criteria based review
standards and standards of best practice.
- Facilitate quality health care intervention
recommendations.
- Review and assess over/under utilization issues.
- Track, trend and evaluate appropriateness and quality of care
issues with the implementation of education to internal and
external customers and process improvement initiatives.
- Respond to inquiries by provider/site employees relating to
standards of care and best practices.
- Develop and maintain pre-established review parameters under
the direction of theYesCareMedical Director.
- Identify and document comparisons with community standards,
regionally based as indicated.
- Communicate and guide staff and physicians regarding
utilization management program development, implementation,
evaluation and reporting.
- Work with other UM inpatient and outpatient nurse reviewers to
assure proper treatment in the appropriate setting at the
appropriate time.
- Communicate and document any issues relating to the
outpatient/inpatient UM process to the Manager of Utilization
Management.
- Assist with the data collection and reporting related to the UM
outpatient/inpatient process.
- Participate in CEU offerings/seminars to enhance professional
growth and development and the maintenance of nursing license.
- Recommend improvements to process and outcomes using data
analysis tools, logical rules/relations and data elements.
- Performs miscellaneous job-related duties as assigned. 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 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. Join Our Talent Community ID 9
Job Locations US-TN-Brentwood Category Corporate Position Type
Regular Full-time Shift / Schedule Weekday Day Location ID
99610
Keywords: YesCare Corporation, Franklin , UM Nurse Specialist, Healthcare , Brentwood, Tennessee
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