Outcomes Manager

This is a fully remote position, open to applicants in Arizona, +17 more states.

📋 Description

• Implement suitable medical necessity tools to ensure compliance while achieving cost-effective and favorable patient outcomes.

• Serve as a resource for UR Tech and AA team members to enhance UR and revenue cycle processes.

• Employ payer-specific screening tools to aid in assessing the level of service and medical necessity.

• Collaborate with the Physician Advisor regarding medical necessity, length of stay, and appropriateness of care.

• Detect and manage concurrent and retroactive denials through effective communication with physicians, case management, multidisciplinary teams, external physician resource groups, and payers.

• Complete clinical review and denial management documentation within case management and billing systems.

• Oversee concurrent denial processes and direct referrals to appropriate resources for concurrent and retrospective appeals.

• Prepare and conduct audits utilizing suitable screening tools and documentation.

• Achieve job-specific goals, objectives, and dashboard metrics.

• Engage in organizational improvement initiatives, committees, departmental/divisional teams, and community activities.

• Comprehend and apply relevant federal and state regulations.

• Identify and report compliance issues as necessary.

⛳️ Requirements

• RN license is required.

• Minimum of 3 years of clinical nursing (RN) experience.

• Preferred 1 year of experience in UR/CM/QM.

• Fundamental understanding of Medicare, Medicaid, and managed care.

• Background in discharge planning or home health is desirable.

• Exceptional verbal and written communication abilities.

• Strong problem-solving, critical thinking, and conflict resolution skills.

• Graduate of an accredited School of Nursing.

• Must hold a Registered Nurse license from the State of New Jersey.

• Case Management Certification is required within one year of hire, starting from April 1, 2015.

🏝️ Benefits

• Medical/prescription insurance.

• Dental insurance.

• Vision insurance.

• Health and dependent care flexible spending accounts.

• 403(b) (with 401(k) subject to collective bargaining agreement).

• Paid time off.

• Paid sick leave as mandated by state and local paid sick leave laws.

• Short-term disability.

• Optional long-term disability.

• Colleague and dependent life insurance.

• Supplemental life and AD&D insurance.

• Tuition assistance.

• Employee assistance program, including free counseling sessions.