Utilization Manager- Emergency Medicine (Remote)

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Utilization Manager (Emergency Medicine) to join our growing team.

Job Summary:

• The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements.

Responsibilities:

• Review and interpret patient records to determine medical necessity and appropriateness of care; determines if medical record documentation supports the need for services.
• Quickly assess data and information accurately for diagnoses and appropriate treatment recommendations
• Review hospital notes to identify life or limb-threatening diagnoses - including records from emergency and critical care services, oncology services, and dialysis services.
• Review requests from doctors for prescriptions and associated diagnoses
• Foster positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Responsible for attending training and scheduled meetings and for maintenance and use of current/updated information for review.
• Maintain medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, adherence to HIPAA polices.
• Utilize proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health policies, procedures and guidelines
• Actively cross-train to perform duties of other contracts within the Acentra Health network to provide a flexible workforce to meet client/consumer needs.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Required Qualifications

• Bachelor's Degree from an accredited college or university
• Minimum 5 years nursing experience
• Eligible to obtain MN RN license; a compact license is not acceptable in MN
• Medical record abstracting skills required.
• Knowledge of medical terminology and disease process required.
• Strong clinical assessment and critical thinking skills
• Knowledgeable of CPT/HCPC codes
• Excellent verbal and written communication skills required.
• Ability to work in a team environment.
• Ability to work in a fast-paced environment and make decisions quickly and confidently
• Flexibility and strong organizational skills needed.
• Must be proficient in Microsoft Office and internet/web navigation.

Preferred Qualifications

• Knowledge of current URAC standards strongly preferred.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Careers - Acentra Health

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.