Who we are:
IHCS provides an Integrated Delivery System in the home setting, which includes, DME, Respiratory, Home Health and Home Infusion services. IHCS has a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients – 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1
With over 30 years of experience, we are the trusted market leader in Home Health, Durable Medical Equipment, and Home Infusion Services. If you are passionate about inspiring, motivating, and leading teams this opportunity could be for you and we want to hear from you!
Join our team as we strive for excellence through teamwork. We are committed to delivering high quality care to our patients through Exceptional Customer Service, Proven Outcomes, and Seamless Care.
Full time team members competitive compensation package, include but not limited to;
- Medical, Vision, Dental, Short- and Long-term insurance
- 6+ Days of Holidays Pay
- 15+ days of PTO
- Employer paid life insurance
- 401K with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
- Comprehensive paid training program
What will you be doing:
As a Utilization Management Nurse, you will ensure that home health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive home healthcare.
- Concurrent review of patient’s clinical information for efficiency
- Ongoing review of precertification requests for medical necessity
- Coordinates patient care needs with a multi-disciplinary healthcare team
- Maintain accurate records of all patient related interactions
- Ability to stay organized and interact well with others in any situation
- Provide updates to Manager of Utilization Management for review
What will you come with:
- Knowledge of health, home care, managed care, hospital and hospice care
- Experience in care management; including care plan development and maintenance, care coordination and ability to interpret insurance policy language preferred
Minimum Requirements:
- Associates degree in Healthcare Administration, Public Health, Nursing, or related field; equivalent experience accepted.
- Minimum 3 years of experience in healthcare quality auditing, regulatory compliance, or performance improvement.
- Strong understanding of CMS, NCQA, URAC, Medicaid/Medicare, and HIPAA regulations.
- Proficiency with Microsoft Office Suite, audit and risk management tools, and data analysis platforms.
- Demonstrated experience in developing training programs and performance evaluation tools.
- Strong analytical, documentation, and verbal/written communication skills.
Preferred Qualifications:
- Clinical or audit experience in managed care, home health, hospice, or DME.
- Certification(s) such as CPHQ, CHC, or other quality/audit/compliance credentials.
- Experience designing employee scorecards or using audit tracking platforms.
Join our team as we strive for excellence through teamwork, where our patients are #1!
IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
Behaviors
Preferred
- Enthusiastic: Shows intense and eager enjoyment and interest
- Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
- Dedicated: Devoted to a task or purpose with loyalty or integrity
Motivations
Preferred
- Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
- Self-Starter: Inspired to perform without outside help
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.