Case Manager/ Utilization Review RN, FT days- REMOTE

About the position

The Utilization Review (UR) Coordinator works, in collaboration with a multidisciplinary team that includes, but is not limited to, physicians, nurses, patient access, and billing staff, along with external insurance payers, to ensure patients progress along the continuum of care in an efficient and cost-effective manner that ensures quality outcomes. UR Coordinator utilizes established guidelines to support appropriate level of care throughout hospitalization and serves as a liaison between the hospital and external payers on issues related to severity of illness and intensity of service for patients to ensure appropriate and timely utilization of hospital services.

Responsibilities

• Collaborate with a multidisciplinary team including physicians, nurses, and billing staff.
• Ensure patients progress along the continuum of care efficiently and cost-effectively.
• Utilize established guidelines to support appropriate level of care throughout hospitalization.
• Serve as a liaison between the hospital and external payers regarding severity of illness and intensity of service.
• Ensure appropriate and timely utilization of hospital services.

Requirements

• Current GA RN license.
• BLS required - must be obtained within initial 90-days of employment.
• Graduate of an accredited school of nursing.
• Minimum of 3-5 years experience in nursing, preferably in a hospital setting.
• Minimum of 1 year in case management, utilization management, or discharge planning preferred for RN.

Nice-to-haves

• Certification in case management preferred.
• BSN recommended.
• Excellent communication skills.
• Excellent interpersonal skills.
• Excellent critical thinking skills.