• Job Description

  Req#: 395991
  Details
  
  
  • Department: Utilization Managment
  • Schedule: PRN to cover PTO and extended leaves. Monday - Friday. 8am-4pm. Variable schedule.
  • Hospital: Ascension Borgess
  • Location: Kalamazoo, MI
  
  Benefits
  
  
  Paid time off (PTO)
  Various health insurance options & wellness plans
  Retirement benefits including employer match plans
  Long-term & short-term disability
  Employee assistance programs (EAP)
  Parental leave & adoption assistance
  Tuition reimbursement
  Ways to give back to your community
  Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, performance and salary range at the time of the offer.
  
  Responsibilities
  
  
  Provide health care services regarding admissions, case management, discharge planning and utilization review.
  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.
  
  Requirements
  
  
  Licensure / Certification / Registration:
  • Registered Nurse credentialed from the Michigan Board of Nursing obtained prior to hire date or job transfer date required.
  Education:
  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
  
  Additional Preferences
  
  
  BSN preferred.
  2 yrs Utilization Management experience highly preferred.
  
  Why Join Our Team
  
  
  Ascension Michigan operates 16 hospitals and more than 300 related healthcare facilities that together employ nearly 23,000 compassionate associates. When you join our care teams, you join a team dedicated to providing spiritually centered, holistic care which sustains and improves the health of the communities we serve throughout Michigan.
  Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.
  Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.
  
  Equal Employment Opportunity Employer
  
  
  Ascension will provide equal employment opportunities (EEO) to all associates and applicants for employment regardless of race, color, religion, national origin, citizenship, gender, sexual orientation, gender identification or expression, age, disability, marital status, amnesty, genetic information, carrier status or any other legally protected status or status as a covered veteran in accordance with applicable federal, state and local laws.
  For further information, view the EEO Know Your Rights (English) poster or EEO Know Your Rights (Spanish) poster.
  As a military friendly organization, Ascension promotes career flexibility and offers many benefits to help support the well-being of our military families, spouses, veterans and reservists. Our associates are empowered to apply their military experience and unique perspective to their civilian career with Ascension.
  Pay Non-Discrimination Notice
  Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.
  This Ministry does not participate in E-Verify and therefore cannot employ STEM OPT candidates.
  
  
  Licensure / Certification / Registration:
  • Registered Nurse credentialed from the Michigan Board of Nursing obtained prior to hire date or job transfer date required.
  Education:
  • Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
  
  
  Provide health care services regarding admissions, case management, discharge planning and utilization review.
  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.

• About the company

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