RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus)

Temple University Health System • Philadelphia, PA

6d • Hybrid

About The Position

TUH-Jeanes Campus, in Northeast Philadelphia, offers a unique combination of advanced medical and surgical services in a convenient, easy-to-access community setting. A member of Temple Health, TUH-Jeanes Campus has many services that are typically only found at downtown hospitals, including advanced cardiac, neurologic and orthopedic surgery. TUH-Jeanes Campus' experienced doctors and dedicated staff offer patients access to many of the latest treatments and diagnostics, while never losing sight of its commitment to providing a compassionate, personal touch. Utilizing InterQual and other appropriate criteria, responsible for reviewing all admissions and continued stay of patients in conformance with the established criteria set forth in the hospital's utilization management and quality assurance plan. Will determine the medical necessity for admission and continued stays for patients within department's scope of service and to meet the hospital's objectives for assuring a high quality of patient care as well as assuring the effective and efficient utilization of available health services. Identifies appropriate level of care for inpatients and outpatients requiring overnight care.

Requirements

• Graduate of an accredited school of nursing
• BSN Required
• 2 years experience in clinical nursing preferably in acute care
• PA Registered Nurse License Required or Multi State Compact RN License Required

Nice To Haves

• General Experience in utilization review, case management, PreCertification, or discharge planning
• General Experience and knowledge of Medicare, Medicaid, and commercial insurance guidelines
• General Experience and knowledge of MCG and InterQual criteria tools

Responsibilities

• Reviewing all admissions and continued stay of patients in conformance with the established criteria set forth in the hospital's utilization management and quality assurance plan.
• Determine the medical necessity for admission and continued stays for patients within department's scope of service and to meet the hospital's objectives for assuring a high quality of patient care as well as assuring the effective and efficient utilization of available health services.
• Identifies appropriate level of care for inpatients and outpatients requiring overnight care.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level