RN Case Manager - Utilization Review
About The Position
St. Francis Medical Center seeks an RN Case Manager responsible for the quality and resource management of patients admitted to the facility, from admission throughout the continuum of healthcare management. The role advocates for patients, promotes cost containment, and provides leadership to integrate healthcare providers for a seamless delivery of care. The position facilitates quality, clinical, and cost-effective outcomes by conducting holistic, comprehensive admission and concurrent medical-record reviews for 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 and knowledge.
Nice To Haves
- Five years of acute care nursing experience.
- CCM certification, or ability to obtain it within one year.
- Knowledge of Milliman Criteria and InterQual Criteria.
- Current BCLS certificate.
Responsibilities
- Manage the quality and resources of patients admitted to the facility from admission throughout the continuum of healthcare management.
- Advocate on behalf of patients and promote cost containment.
- Provide leadership to integrate healthcare providers and support seamless delivery of care.
- Conduct holistic, comprehensive admission and concurrent medical-record reviews for medical necessity, intensity of service, and severity of illness.
- Facilitate quality, clinical, and cost-effective outcomes.
Benefits
- Paid time off
- 401K retirement plan
- Medical coverage
- Dental coverage
- Vision coverage
- Tuition reimbursement
- Voluntary benefit options
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
