case manager

case manager Long Beach, CA

MemorialCare
Full Time Long Beach, CA 58.95 - 40.65 USD HOURLY Today
Job description

Case Manager, URP, (LVN) - FT/Days (8hrs) - Long Beach

- (MIL003361)
Description


At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

Position Summary

The Utilization Review Professional, uses decision trees, standard work and clinical expertise works to obtain authorizations for payment by timely management of cases not paid as expected for any number of reasons including but not limited to LOC authorizations, denials and billing disputes. The Utilization Review Professional analyzes charges, reimbursement and contract information to determines appropriate chart, telephonic and/or written justification and timely transmits the information, as well as performs any needed follow up required to obtain the authorization.




Essential Functions and Responsibilities of the Job



  • Completes assigned work queues daily by analyzing contracts, authorizations and MD orders and chart documentation using clinical expertise to determine appropriateness of authorizations/payments received.


  • Manages accounts in assigned work queues daily utilizing decision trees, standard work and clinical expertise to pursue authorizations for denials and billing disputes.


  • Analyzes charges, reimbursement and contract information to determine appropriate chart, telephonic and/or written justification

  • Reviews documentation in the billing system of activities and ensures that authorizations are complete and timely.


  • Performs any needed follow up required to obtain completed authorizations.


  • Duties performed meet standard work, department productivity and timeliness requirements.


  • Other duties as assigned.



Pay Range: $40.65/hr - $ 58.95/hr

Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.


Qualifications


Qualifications:

4+ years' experience as a licensed health care professional in acute or ambulatory medical setting. Or minimum 2 years experience as a URA II.

Education/Licensure/Certification:

LVN Licensure in California required.

Apply Here

About MemorialCare

CEO: Barry Arbuckle
Revenue: $1 to $5 billion (USD)
Size: 10000+ Employees
Type: Nonprofit Organization
Website: https://www.memorialcare.org
Year Founded: 2005

case manager
MemorialCare

https://www.memorialcare.org
Fountain Valley, CA
Barry Arbuckle
$1 to $5 billion (USD)
10000+ Employees
Nonprofit Organization
Health Care Services & Hospitals
2005
Related Jobs

All Related Listed jobs

154061 Arts Therapist – entry level (KK)
NHS Scotland Edinburgh, Scotland 37831 - 46100 GBP ANNUAL Today

The Arts Psychotherapies Service provides Art, Music, Drama Psychotherapy services to children, young people, adults and older adults with complex needs across

General Practice Administrative Assistant (GPA)
Orchid House Surgery Ferndown, England 10.42 GBP HOURLY Today

Working alongside the visiting team to ensure ward rounds and personalised care plans are conducted, as well as ensuring new patients are reviewed within 7 days

Bar/Waiting Staff
Landmark Cafe Grimsby, England 7.01 - 12.32 GBP HOURLY Today

Taking cash or card payments from customers. Verifying the age and checking the identification of potential customers under the Challenge 25 strategy.

MS Dynamics Functional Consultant - London
Opus Recruitment Solutions London, England 60000 - 65000 GBP ANNUAL Today

Strong data analysis and implementation experience. You'll be proficient in Dynamics with a natural flair for testing reviews; testing approach methodology,

Import / Export Operator
DB Schenker Nuneaton, England Today

Maintain proactive communication with internal and external customers. Investigate and promptly respond to all customer queries and complaints.