Utilization Review Nurse-RN - Main Case Management - Full Time - Days

The Christ Hospital Health Network • Cincinnati, OH

2d • Onsite

About The Position

To maintain high-quality, medically necessary, evidence-based care, and efficient treatment of all patients, regardless of payment source, by ensuring the patients receive the right care, at the right time, in the right place. Utilize an Integrated Case Management Model. Under this model the Case Managers will follow patients through the continuum while facilitating the functions of utilization review, utilization management, and cost containment. Track and trend denials and payor issues to provide feedback and education to payer relations and the case management department.

Requirements

• Registered Nurse (RN) license
• Experience in case management
• Knowledge of utilization review principles
• Knowledge of utilization management principles
• Knowledge of cost containment strategies
• Ability to track and trend denials and payor issues
• Ability to provide feedback and education

Responsibilities

• Facilitate the functions of utilization review, utilization management, and cost containment.
• Track and trend denials and payor issues.
• Provide feedback and education to payer relations and the case management department.

What This Job Offers

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