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

Temple University Health System • Philadelphia, PA

7d • Hybrid

About The Position

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
• PA Registered Nurse License or Multi State Compact RN License

Nice To Haves

• 2 years experience in clinical nursing preferably in acute care
• Experience in utilization review, case management, PreCertification, or discharge planning
• Experience and knowledge of Medicare, Medicaid, and commercial insurance guidelines
• 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.
• Determining 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.
• Identifying appropriate level of care for inpatients and outpatients requiring overnight care.

What This Job Offers

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