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

Temple University Health System • Philadelphia, PA

3h

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 Required
• Bachelor's Degree BSN Required
• 1 year experience of recent Utilization Review in acute care or in insurance company setting. Required
• 1 year experience in medical-surgical setting. Required
• 1 year experience in working with competency utilizing InterQual criteria. Required
• General Experience in working with utilization review standards Required
• PA Registered Nurse License Required
• Multi State Compact RN License Required

Nice To Haves

• Certified Case Manager Preferred

Responsibilities

• Reviewing all admissions and continued stay of patients
• Determine the medical necessity for admission and continued stays for patients
• Assuring a high quality of patient care
• 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