Utilization Review Case Manager

Utilization Review Case Manager – Home Health

.6 FTE/24 per Week, Days

Why work as a Utilization Review Case Manager at Visiting Nurse and Hospice for Vermont and New Hampshire?

• You experience satisfying and challenging work that makes a difference, every day.
• You really get to know your patients and become an integral part of their care team.
• You are provided broad independence but are also part of a cohesive interdisciplinary team.
• You get to be an important part of the community where you live.
• You have a work/life balance that can match the flexibility you need.

Benefits include:

• Employee Referral Bonuses
• Clinical CEUs
• Online LinkedIn Learning

Locations:

• Fully remote work in all states except: CA, CT, MA, MD, NJ, NY, OH, RI, WY.

Visiting Nurse and Hospice for VT & NH covers more than 70 towns delivering superior nursing, rehabilitation, hospice, and personal care services with proven effectiveness, integrity, and compassion. Our only goal is to help the people in our communities. When you join Visiting Nurse and Hospice for VT & NH, you’ll become part of a dedicated team delivering outstanding home health and hospice services that enrich the lives of the people we serve.

Utilization Review Case Managers at VNH focus on providing pain management and comfort for patients with terminal or chronic illness, as well as communicate and coordinate care needs with the interdisciplinary team, the patient and their families/caregivers.

The URCM:

• Collaborates with primary clinician, provider, patient, their family and/or the primary care givers upon admission to create a plan for patient’s care.
• Continuously reviews the patient’s plan of care and collaborates with primary clinician throughout patient’s episode to ensure the patient’s plan of care aligns with care being provided.
• Coordinates and manages the patient’s plan of care, including but not limited to: order review, resource management, measuring outcomes, and communication and collaboration with patient, caregiver and attending provider.
• Collaborates with primary clinician in identifying need for referral for interdisciplinary services.
• Utilizes key performance indicators associated with value-based purchasing, patient driven grouping models, and patient satisfaction to guide patient care and utilization.
• Completes clinical review of referrals and collaborates with the intake and referral teams.
• Demonstrates knowledge of Medicare regulations and delivers care in accordance with Medicare Condition of Participation (CoP).
• Reviews usage of supplies and equipment in patient care.
• Collaborates with Home Health Manager in identifying items such as: patient concerns, educational opportunities for clinicians, trends, etc.
• Escalates anticipated or actual safety concerns to appropriate leader.
• Completes chart reviews and special projects as directed by Director of Quality and Patient Safety.

Minimum Qualifications:

• Graduate of an accredited school of nursing.
• Current RN license in both VT and NH or compact.
• Minimum of 2 years’ experience in Home Health
• Adept at navigating the Electronic Medical Record
• Proficiency in Excel and Word systems

Dartmouth Health is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.