Case Management Utilization Review RN - REMOTE ID-2578

January 2, 2025

The Care Manager assumes primary responsibility for documentation of appropriate medical necessity for the inpatient status or placement in observation. Communicates with the physicians and clinicians. Assures clinical information is sent to the payor timely to complete the authorization of the patient stay. Collaborates and coordinates with other allied health professionals to ensure quality care is provided and desired outcomes are achieved in a timely and cost-effective manner.

KEY RESPONSIBILITIES:

Utilizes a complete and systematic methodology/process to assess, plan, implement, evaluate and provide patient care coordination from pre-hospital through post-hospital care.
Assists in the development of physician profiles to identify over/under utilization patterns.
Supports Steward Health Care's and hospital goals and objectives. Works within regulatory compliance guidelines.
The Care Manager works collaboratively with all healthcare disciplines to assure appropriate and timely services.
Assesses the medical appropriateness, quality, and cost-effectiveness of proposed hospital, medical, and surgical services.
Collaborates with the multidisciplinary team to assist patient with benefits management.
Communicates with payers to obtain authorization.
Identifies and plans strategies to optimize inpatient length of stay and resource utilization.

REQUIRED KNOWLEDGE & SKILLS:

Ability to work competently with computer-based charting and other clinical and non-clinical software programs.
Adaptability to change and good organizational skills required. Ability to read and communicate effectively in English.
Can be expected to do presentations as directed. Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance carrier’s coverage details.
Ability to advocate for patients. Ability to operate office equipment. Possess critical thinking skills.
Leadership skills required for role include effective mentoring, coaching, counseling, time management, problem solving, and strategic planning.
Demonstrates initiative and proactive approach to problem resolution.
Ability to effectively interact with insurance companies and community healthcare recourses.
Ability to work in a stressful, fast paced environment.
Must master Microsoft Office Products, i.e. Excel, Word etc.
Understand CMI, patient status, InterQual Criteria, Milliman Criteria, and Transfer DRGs.
Has the maturity to work independently and remotely.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

Education: Bachelor’s degree required; Master’s degree preferred.
Experience (Type & Length): Three to five years of acute medical/surgical experience plus three to five years of Case Management experience.
Certification/Licensure: RN license required; Certification in Case Management (CCM) strongly preferred.
Software/Hardware: Strong knowledge in Microsoft Office applications – Word, Excel, Access, PowerPoint.
Other: Understanding of the health care delivery setting.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

DISCLAIMER

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

5. HOW DO YOU PROCESS INFORMATION?

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

8. HOW TO PRIORITIZE WORK?

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

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