RN Case Manager - Utilization Review
Start Date: ASAP
Length: 12 weeks
Shift: Days (potential evenings/nights)
Requirements: -Graduate from a school of nursing. BSN preferred.
Licensure / Certification: Current license to practice as registered nurse in the State of Ohio. CCM, ACM or CPHM preferred.
Experience: Minimum of 3-5 years recent clinical experience in an acute care setting. Utilization review or case management experience required.
Performs utilization review and payer notification in a timely manner.
Coordinates with the multi-disciplinary team in meeting patient care goals.
Educates patient, families and other members of the care team about the financial out of pocket expense or financial responsibility of the patient. Advocates for patients' rights. Delivers notifications to patients in compliance with CMS regulations. Educates hospital leadership and staff to current case management practices, patient coordination issues, and unit specific trends. Provides consultation to professional staff and physicians on level of care determinations, CMS regulations and payer specific guidelines. Accurately and completely documents clinical reviews in accordance with documentation standards, policies, procedures and/or guidelines.