Virtua Health

Virtua Health, established in 1880, is a leading academic health system in southern New Jersey committed to helping individuals be well, get well, and stay well

Outcomes Manager – UR

Location

New Jersey

Posted

5 days ago

Salary

$38 - $59 / hour

Seniority

Senior

Associate Degree3 yrs expEnglish

Job Description

Outcomes Manager – UR

Virtua Health

• Responsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes • Acts as a resource to other team members including UR Tech and AA to support UR and revenue cycle process • Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity • Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues • Identify and manage concurrent and retroactive denials through communication with attending physicians, case management, multidisciplinary team, external physician resource group and payers • Appropriate and complete documentation of clinical review and denial management in the case management documentation system and in the billing system • Manages the concurrent denial process by referring to appropriate resource for concurrent and retrospective appeal activity process • Prepares and facilitates audits using appropriate screening tools and documentation • Accountable to job specific goals, objectives and dashboards which contribute to the success of the organization • Participates in organizational improvement activities including patient satisfaction, Six Sigma committee, department and/or divisional teams and community activities • Understands and applies applicable federal and state requirement • Identify and reports compliance issues as appropriate

Job Requirements

  • 3 years clinical nursing (RN) experience and 1 year UR/CM/QM experience or 3 years experience as Clinical Social Worker
  • Basic understanding of Medicare, Medicaid and managed care
  • Discharge planning or home health background
  • Excellent verbal and written communication skills
  • Problem solving skills
  • Critical thinking skills
  • Conflict resolution skills
  • Licensure from the State of New Jersey as a Registered Nurse
  • Case Management Certification (requirement within one year of hire beginning April 1, 2015)

Benefits

  • medical/prescription insurance
  • dental insurance
  • vision insurance
  • health and dependent care flexible spending accounts
  • 403(b) retirement plan (401(k) subject to collective bargaining agreement)
  • paid time off
  • paid sick leave as provided under state and local paid sick leave laws
  • short-term disability
  • optional long-term disability
  • colleague and dependent life insurance
  • supplemental life and AD&D insurance
  • tuition assistance
  • employee assistance program that includes free counseling sessions

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