Registered Nurse - Utilization Management - 8 Hour Days

Job Summary: Key Job Responsibilities
The Utilization Review Case Manager validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR Case Manager uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient's expected length of stay. The UR Case Manager secures authorization for the patient's clinical services through timely collaboration and communication with payers as required. The UR Case Manager follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.

Educational Requirements:

Assoc. Degree/College Diploma Graduate of an accredited nursing program
Bachelor's Degree Nursing preferred

Licenses:

RN State License
Basic Life Support (BLS)

Experience:

3 years In acute nursing
2 years Case Management preferred

1 year CPT coding preferred

Physical Demands:

Lifting 50 lbs. Carrying 50 lbs. Pushing 75 lbs. Pulling 75 lbs. Balancing, Stooping, Kneeling, Crouching, Reaching, Handling, Grasping, Feeling, Talking, Hearing, Repetitive Motions, Eye/Hand/Foot Coordination