Warbird Consulting Partners

  • Traveling Utilization Review RNs

    Location
    National
    Pos. Category
    Healthcare - Consulting
    Experience (Years)
    3
    # Positions
    2
    Job ID
    6635
  • Job Description

    Warbird is seeking Interim Utilization Management Consultants for TRAVEL PROJECTS we have in the pipeline to assist our clients with the development and implementation of a strong and effective infrastructure for the Utilization Management (UM) function across the organization and to manage the day to day operations.

     

     Non-Manager/Consultants will:

    • Provide clinical reviews against standard criteria for evaluating medical necessity for hospitalization, regardless of payor type
    • Assist other members of the healthcare team regarding the appropriate use of resources and timely follow-through with the plan of care
    • Provide ongoing communications with health plan utilization departments regarding medical necessity for prospective, concurrent, and retrospective reviews
    • Intervene when potential denials are determined and facilitates appeals when concurrent denials are received and partners with physicians related to appropriateness of admission and the prevention of denials
    • Facilitate peer to peer appeal for concurrent denials
    • Fax reviews per policy and as needed to stay current on certified days
    • Assign a working diagnosis related groups (DRGs) on all patients
    • Communicate with attending physician regarding patients who do not meet criteria to identify additional documentation needs or potential status change
    • Perform chart analysis on quality surveillance and special studies as requested

    The ideal candidate has the ability to analyze documentation of clinical care; has excellent written and verbal communication skills; is a critical thinker and has excellent time management skills.

     

    Manager or Directors will:

    • Develop optimum staffing guidelines given current daily practices and revise these guidelines as new workflows are implemented
    • Provide support and recruitment, training and integration of a permanent UM Manager
    • Develop future-state department roles and responsibilities based upon optimal function of the UM Department
    • Assist or lead the design in a Department “Playbook” to capture essential policies, procedures, processes, job-aides and guides to daily practice
    • Design and implement process flows for emergency department, inpatient, observation, hospital-issued notices of non-coverage, Medicare outpatient observation notice and condition code 44
    • Develop a methodology to obtain data from UM daily functions necessary for root cause analysis aimed at preventing denials
    • Implement daily, weekly and monthly reporting packages to include key performance matrix
    • Develop payer contracting matrix identifying payer communication requirements related to UM functions and data requirements
    • Implement a process to track payor denials to include timely filing, medical necessity, prior authorization and other denial types impacted by the UM Department daily functions
    • Work with the UM Manager to create a interim solution to drive and track daily UM activities while the client evaluates, identifies and implements a technology solution

    Job Requirements

    EDUCATION/CERTIFICATIONS/REQUIREMENTS:

    • Bachelor’s Degree in Healthcare, Business or related field is required
    • RN required
    • +3 years’ experience overall within Utilization Management/Authorization/etc., or three to five (3-5) years of experience in revenue cycle processes/integrity/case utilization
    • Excellent written, organizational, analytical, motivational and critical thinking skills
    • Knowledgeable of utilization management as it relates to RAC preparedness and third-party payers; knowledgeable of post-acute care community resources
    • Excellent verbal and written communication skills; ability to engage with all clinical and financial leaders in achieving organizational deliverables

     

    Traveling roles  - ALL TRAVEL RELATED EXPENSES PAID PLUS PER DIEM FOR MEALS. Projected projects can be 4-6 months or 6-12 months in length; weekly travel from Mon-Thursday required for each week, then 3 weeks each month once settled into a routine as some remote time becomes available.

     

    Warbird offers full benefits, including medical, dental, paid vacation time, etc. after eligibility is met.

     

    Warbird is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data, religion or other legally protected status.  E-Verify - Warbird participates in the Electronic Employment Eligibility Verification Program.

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