The CASE MANAGER, RN will assist in the development, planning, coordination and administration of the activities involved in Utilization Review and Discharge Planning. This position will perform daily reviews of medical records to determine appropriateness and medical necessity of admission, continued hospital stay and use of ancillary services. These duties may be performed on site or telephonically depending on the location.
•Current Alabama RN license
•5 years’ clinical experience in acute care, physical or occupational therapy, or skilled nursing and rehabilitation
•Valid driver’s license in good standing
•Basic computer skills
•Knowledge of Medicare and Medicaid Regulations; community resources and medical claims and claims review processes
•Ability to be flexible, adaptable and to work effectively in a variety of settings.
•Excellent customer service skills demonstrated through written and verbal communication
•Case Management or UR experience
•HMO or MCO experience
•Disease Management Experience
VIVA Health - 11 months ago