Job Description

Location: Health Choice Management Co.
Posted Date: 11/13/2020

Position Purpose: The Utilization Review Skilled Nursing Facility (SNF) Nurse completes skilled nursing facility admission and concurrent reviews for Health Choice members, utilizing InterQual criteria and other national standards, Policy and Procedures, and the member’s medical benefits. Reviews are made on-site, telephonically, and via fax. Assists and coordinates the discharge planning needs of the member with the facility staff, attending physician, the member, and his/her support.

Responsibilities:

  • Review all Skilled Nursing Facility (SNF) admissions and initiate discharge planning in a timely manner
  • Review complex, high dollar and lengthy stay admissions
  • Utilize clinical skills, chart review, PHY communication, and InterQual standards for approval of Skilled Nursing Facility (SNF) stay
  • Conduct ongoing review for members in Skilled Nursing Facility (SNF) stay including reviewing requested procedures, DME, home health or pharmaceutical needs while skilled or upon discharge utilizing peer review, as necessary
  • Participate in weekly Skilled Nursing Facility (SNF) Rounds
  • Communicate with Medical Director(s) for determination on reviews that do not meet criteria
  • Provide notification to facility of determination
  • Initiate interdepartmental coordination to ensure quality and timely care for members
  • Coordinate discharge planning to create member’s post-skilled plan
  • Interact with social worker, community agencies to identify alternate delivery of services
  • Evaluate the need for case management and transition of care services following skilled stay
  • Coordinate transportation with contracted vendors following skilled stay

Education / Experience / Other Requirements

Education:

  • Associate’s degree or Bachelor’s degree from an accredited Nursing School required
  • Current AZ nursing license

Years of Experience:

  • Previous UR/Discharge planning experience preferred
  • Previous Medicaid/Medicare experience preferred Prior supervisor experience

Specialized Knowledge:

  • InterQual criteria
  • Strong knowledge of care management and care coordination
  • Proficiency in computer and technology utilization required, including, but not limited to: care management software, data-analytics software, Microsoft Office Products (Outlook, Excel, Power Point, Word, Visio)

Skills & Abilities:

  • Ability to manage multiple projects and prioritize adhere to deadlines/time frames
  • Complete tasks with little supervision
  • Ability to manage large workload

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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