Case Manager (RN) - Utilization Management
About The Position
The Case Manager (RN) is responsible for quality and resource management for patients admitted to the facility, from admission and throughout the continuum of health care management. The role advocates on behalf of patients, promotes cost containment, and demonstrates leadership in integrating health care providers to support seamless delivery of care. The methodology facilitates quality, clinical, and cost-effective outcomes. The Case Manager performs holistic and comprehensive admission and concurrent medical-record reviews to assess medical necessity, intensity of service, and severity of illness.
Requirements
- At least five years of work experience after graduation from an accredited school of nursing.
- Current state Registered Nurse license.
- At least one year of experience in case management, discharge planning, or nursing management.
- Basic to intermediate computer skills.
Nice To Haves
- Five years of acute care nursing experience.
- CCM certification, or willingness to obtain it within one year.
- Knowledge of Milliman Criteria and InterQual Criteria.
- Current BCLS certificate.
Responsibilities
- Manage the quality and use of resources for patients admitted to the facility from admission throughout the continuum of care.
- Advocate on behalf of patients and promote cost containment.
- Integrate health care providers to support seamless delivery of care.
- Facilitate quality, clinical, and cost-effective outcomes.
- Perform holistic and comprehensive admission and concurrent reviews of medical records for medical necessity, intensity of service, and severity of illness.
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What This Job Offers
Career Level
Mid Level
Education Level
No Education Listed
