Case Management UR RN, Full Time

Job Description

Job Description

Job Summary :

Assume primary responsibility of cases for documentation of appropriate medical necessity for the third-party payer's inpatient and / or observation status post discharge. Reviews audits / denials and appeals on patient and facility behalf discharged population to include governmental, managed Medicare and commercial entities. Communications with physician, ancillary staff, and payers and assists third party payers with clinical information for approval of stay and payment. Assists Director in appeals of stay that are denied, sets up physician to physician denials. Assures proper level of care assignment. Facilites with Case Managers and other allied health professionals to promote and ensure that quality care is provided and outcomes are achieved a timely and cost-effective manner. Supports hospital goals and objectives in compliance with regulatory guidelines. Works in collaboration with all healthcare disciplines to assure a continuum of appropriate and timely services. Assess appropriateness, quality, and cost effectiveness of proposed hospital, medical and corporate goals and objectives.

Education :

Must be a graduate of an accredited school of Nursing, RN preferred.

Experience :

Prefer a minimum of four-year experience in hospital setting. One-year experience in utilization management / case management is preferred.