Job Description Description Registered Nurse Care Manager Utilization Review Specialist AdventHealth New Smyrna Beach Location Address: 401 Palmetto Street, New

…REGISTRATION PREFERRED: * Certification specialty preferred in Utilization Management, managed care or other applicable professional certification. SUPERVISORY

Full Time/Monday - Friday DaysPOSITION PURPOSEUnder the supervision of the Home Care Nurse Manager the Home Care Nurse improves the patient and family's

…* Functions as a liaison for management staff, administration, physicians, managed care companies, community organizations, and other customers. *

…required to have a working knowledge of ICD9, CPT and HCPCS coding and managed care . Responds to incoming telephone calls and (per provider instructions) calls

…assure that appropriate physician admits patient under theguidelines of the Managed Care Companies thus facilitating the authorizations.Demonstrates good

…med-surg experience required.Previous case management experience preferred.Knowledgeable of government/ managed care review process for medical necessity

…Previous utilization management experience preferred. * Knowledge of Medicare/Medicaid, Managed Care and Commercial insurance review processes preferred.*

….Help clinical team build and foster a medical home environmentHelp implement insurance/ managed care compliance methodology within clinical team Participate in

Position Summary: Assures competent, compassionate and individualized nursing care for a group of patients within a unit or other primary area of practice. Ensures