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.

Join Our Talent Community

ID 2024-18851

Job Locations US-FL-Bartow

Category Healthcare Support

Position Type Regular Full-time

Location ID 00834