Description
POSITION SUMMARY : Registered Nurse uses approved screening criteria (MCG® / CMS Inpatient List) to determine the medical necessity of a requested hospitalization and the appropriate level of care for that patient.
Actively involved in the continued management of patient status / LOC. Provides consultative role as utilization management nurse to clinical and non-clinical departments.
Documents objective findings against approved indicators. Assists with retrospective reviews and medical necessity denials per communication with third party payors.
Follows UR policies and procedures and assists with continually improving the quality and effectiveness of the utilization management program at CSVRMC.
Requirements
EDUCATION : Graduate of an approved school of nursing, BSN preferred.
CERTIFICATION / LICENSES : Current licensure as an RN in New Mexico mandatory.
SKILLS :
- Excellent reading, writing, and editing skills in English.
- Strong organizational skills.
- Knowledge of or ability to learn MCG® for determining criteria.
- Ability to effectively evaluate physician orders and medical records.
- Competent computer skills for word processing, data collection, and retrieval.
- Ability to analyze and create reports.
EXPERIENCE : Minimum of five years of experience in a health care setting, of which a minimum of two years has been spent in an acute care setting.
Experience with utilization management, knowledge of MCG ® / criteria, managed care language, and CMS rules and regulations preferred.
NATURE OF SUPERVISION :
Responsible to : Manager of Case Management
ENVIRONMENT : Blood borne Pathogens : A
Office setting. Rotating shifts and weekends when necessary. Must be able to adjust to frequently changing workloads and frequent interruptions.
PHYSICAL REQUIREMENTS :
Ability to move around the hospital to all units / departments for about 10% of the day, in office 90% of the day. Requires close work, good vision, dexterity to write as well as to use computer keyboard.
Utilization Review Coordinator / Case Management /PRN
Follows UR policiesand procedures and assists with continually improving the qualityand effectiveness of the utilization management program atCSVRMC. Experience with utilization management, knowledge ofMCG ®/ criteria, managed care language, and CMS rules andregulations preferred. Actively involved ...
Senior Case Manager RN - Paid Drive Time
One (1) year of supervisory and/or case management experience preferred. Provide direct care and case management of assigned clients. Timeliness of staffing cases post referral. The senior case manager, or similarly qualified alternate, shall be available at all times during operating hours and part...
Utilization Review Coordinator / Case Management / Full-Time
Provides consultative role as utilization management nurse to clinical and non-clinical departments. Follows UR policies and procedures and assists with continually improving the quality and effectiveness of the utilization management program at CSVRMC. Experience with utilization management, knowle...
Utilization Review Coordinator / Case Management / PRN
Provides consultative role as utilization management nurse to clinical and non-clinical departments. Follows UR policies and procedures and assists with continually improving the quality and effectiveness of the utilization management program at CSVRMC. Experience with utilization management, knowle...
Senior Case Manager RN - Paid Drive Time
One (1) year of supervisory and/or case management experience preferred. Provide direct care and case management of assigned clients. Timeliness of staffing cases post referral. The senior case manager, or similarly qualified alternate, shall be available at all times during operating hours and part...
RN Case Manager - Paid Drive Time
Provides case management to assigned clients while directing a team of RNs, LPNs, and caregivers in the delivery of the care to the client. One (1) year of supervisory and/or case management experience preferred. Provide direct care and case management of assigned clients. Timeliness of staffing cas...
Patient Care Coordinator SF Brain and Spine/Full Time
This position requires an excellent working relationship with the physician and the ability to treat patients with respect, privacy and kindness at al times, even in times of stress. Long periods of sitting at times. ...
Case Manager-Case Management/Part-Time
Case Management certification highly desirable – ACM (Accredited Case Manager), CCM (Certified Case Manager, RN-BC (Board Certified in Case Management). The Case Management Coordinator is responsible for identifying, initiating and managing optimal patient flow/throughput to enhance continuity of ca...
RN Case Manager - Paid Drive Time
Provides case management to assigned clients while directing a team of RNs, LPNs, and caregivers in the delivery of the care to the client. One (1) year of supervisory and/or case management experience preferred. Provide direct care and case management of assigned clients. Timeliness of staffing cas...
Seasonal Full Time In Room Dining Coordinator
Seasonal Full Time In Room Dining Coordinator. Whether you work with us, stay with us, live with us or discover with us, we believe our purpose is to create impressions that will stay with you for a lifetime. Are you ready to take the next big step in your hospitality career? Four Seasons Resort Ran...