Case Manager - Utilization Management - RN

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Education and Work Experience

1. Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.
2. Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.
3. Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.
4. Current BCLS (AHA) certificate, preferred.
5. Knowledge of Milliman Criteria and InterQual Criteria preferred.
6. Experience and knowledge in basic to intermediate computer skills.
7. Behavioral Violence Prevention Training within 3 months of hires and maintain current.