Utilization Review Coordinator/Case Manager

Cook Hospital and Care Center•Cook, MN

12h

About The Position

Cook Hospital and Care Center is seeking a Full Time Utilization Review Coordinator/Case Manager to join our team. Summary Join our Team!! Find your belonging with our team of compassionate caregivers who are committed to making a difference in the health and well-being of everyone we serve. Start your career here and create endless opportunities. Day Shift FTE 1.0 Great Environment Excellent Pay & Benefits PTO Sick Time Employee Perks AND MUCH MORE Benefits Cook Hospital & Care Center is pleased to offer the following benefits to all regular full and part-time employees working a .5 FTE (20 hours/week) or above. Employees become eligible on the first day of the month following 90 days of their date of hire. Benefits include medical insurance, flexible spending accounts, retirement plans, long term disability, paid personal time off (PTO, EIB) life insurance, bereavement leave, free wellness center membership, employee assistance program, and earned sick and safe time. Casual employments are eligible to accrue earned sick and safe time.

Requirements

Registered Nurse
Graduate of an Accredited School of Nursing with current MN license to practice.
At least three years of clinical (direct patient care) experience required.

Nice To Haves

Knowledge of utilization review, discharge planning, case management and social work preferred.

Responsibilities

Responsible for reviewing medical necessity for all admissions, extended stays, and outpatient services for all payors in accordance with the mandated regulations and requirements for reviewing medical necessity for all admissions, extended stays, and outpatient services for all payors in accordance with the mandated regulations and requirements.
Works collaboratively with insurance companies for medical care requiring prior authorization.
Will provide assistance where needed in addressing denials as well as the appeals process.
Maintains effective communication and good working relationships with medical staff, other departments, patients and the general public in accordance with hospital policies.
To provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs.
The overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating and functions of case management and discharge planning.
Has accountability for the care, coordination and discharge planning of all patients.
The Case Manager must have the ability to practice under minimal supervision and to perform the following six essential activities of Case Management: Appropriateness of Setting, Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation with emphasis on decreasing length of stay, appropriate discharge planning and monitoring of cost-effective health care across the continuum of care.