UM Case Manager - Utilization Management

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    "ExternalDescriptionStr": "<p><strong>Responsibilities:</strong></p><ol style=\"-webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); box-sizing: border-box; color: rgb(0, 0, 0); font-family: system-ui, -apple-system, BlinkMacSystemFont, &quot;Segoe UI&quot;, Roboto, Oxygen, Ubuntu, Cantarell, &quot;Fira Sans&quot;, &quot;Droid Sans&quot;, &quot;Helvetica Neue&quot;, sans-serif; font-size: 14px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 400; letter-spacing: normal; list-style-type: decimal; margin-bottom: 0.75rem; margin-right: 2rem; margin-top: 0.75rem; orphans: 2; outline-color: rgb(0, 128, 128); padding: 0px; text-align: start; text-decoration-color: initial; text-decoration-style: initial; text-decoration-thickness: initial; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;\"><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Coordinates/facilitates patient care progression throughout the continuum of care.</p></li><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Assures the plan of care and services provided are patient focused, high quality, efficient, and cost effective.</p></li><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Communicates with payer the medical necessity for the status and LOC ordered to obtain authorization and reimbursement for care rendered.</p></li><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Monitors length of stay and ancillary resource use on an ongoing basis and takes actions to achieve continuous improvement in both areas.</p></li><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Communicates information to the Case Management team to aid in appropriate level of care determination and reimbursement by third party payors.</p></li><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Communicates identified issues affecting quality of care, risk management, patient satisfaction and or physician opportunities to the quality team using the Improve the Process form.</p></li><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Ensures that all payer communication is documented for the care team as well as billing.</p></li><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Ability to cover various populations across the organization in relation to Utilization Review.</p></li><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Performs all other duties as requested by Case Manager Supervisor and/or Director.&nbsp;</p></li></ol><p><br><br><strong>Qualifications:</strong></p><ul style=\"-webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); box-sizing: border-box; color: rgb(0, 0, 0); font-family: system-ui, -apple-system, BlinkMacSystemFont, &quot;Segoe UI&quot;, Roboto, Oxygen, Ubuntu, Cantarell, &quot;Fira Sans&quot;, &quot;Droid Sans&quot;, &quot;Helvetica Neue&quot;, sans-serif; font-size: 14px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 400; letter-spacing: normal; list-style-type: disc; margin-bottom: 0.75rem; margin-right: 2rem; margin-top: 0.75rem; orphans: 2; outline-color: rgb(0, 128, 128); padding: 0px; text-align: start; text-decoration-color: initial; text-decoration-style: initial; text-decoration-thickness: initial; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;\"><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">1-2 years of recent acute care hospital experience required</p></li><li style=\"box-sizing: border-box; font-size: 0.875rem; line-height: 1.25rem; outline-color: rgb(0, 128, 128);\"><p style=\"margin-left: 2rem;\">Data entry/computer experience required.&nbsp;</p></li></ul><p><br><br><strong>Requirements:</strong><br><strong>&nbsp;&nbsp;Licenses and Certifications:</strong><br><span style=\"background-color: rgb(255, 255, 255); color: rgb(0, 0, 0); font-family: system-ui, -apple-system, BlinkMacSystemFont, &quot;Segoe UI&quot;, Roboto, Oxygen, Ubuntu, Cantarell, &quot;Fira Sans&quot;, &quot;Droid Sans&quot;, &quot;Helvetica Neue&quot;, sans-serif;\"><span style=\"-webkit-text-stroke-width: 0px; display: inline !important; float: none; font-size: 14px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-decoration-color: initial; text-decoration-style: initial; text-decoration-thickness: initial; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px;\">&nbsp;&nbsp;&nbsp;&nbsp;Registered Nurse</span></span><br>&nbsp;</p>",
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The system currently has 988 licensed beds</span></span><span class=\"TextRun SCXW13032297 BCX8\" style=\"margin: 0px; padding: 0px; font-weight: bold\"><span class=\"NormalTextRun SCXW13032297 BCX8\" style=\"margin: 0px; padding: 0px\">, </span></span><span class=\"TextRun SCXW13032297 BCX8\" style=\"margin: 0px; padding: 0px\"><span class=\"NormalTextRun SCXW13032297 BCX8\" style=\"margin: 0px; padding: 0px\">including Hospice and Behavioral Health. The hospitals within McLeod Health </span><span class=\"NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW13032297 BCX8\" style=\"margin: 0px; padding: 0px; base64,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&quot;))border-bottom: 1px solid transparent\">include:</span><span class=\"NormalTextRun SCXW13032297 BCX8\" style=\"margin: 0px; padding: 0px\"> McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health </span><span class=\"NormalTextRun SCXW13032297 BCX8\" style=\"margin: 0px; padding: 0px\">Clarendon</span><span class=\"NormalTextRun SCXW13032297 BCX8\" style=\"margin: 0px; padding: 0px\"> and McLeod Behavioral Health.&nbsp;</span></span><span class=\"EOP SCXW13032297 BCX8\" style=\"margin: 0px; padding: 0px\">&nbsp;</span></p></span>",
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