Overall responsibility for reviewing the clinical plan of care in comparison to evidence-base practice and regulatory requirements. The position integrates care coordination, utilization management, and discharge planning. Additional responsibility: a) medical necessity screening, b)care coordination c)discharge planning d) facilitating multi-disciplinary patient care conferences e) managing concurrent disputes or payors about levels of care f)making appropriate referrals to other departments
g)participating in weekly Complex Case Reviews h)arranging
for post discharge patient education i)clear, complete and concise documentation in case management software and hard copy documents, j) maintain accuracy of patient demographic and insurance information, k)identify and document potential avoidable days. K) Identify and report over and under utilization.
Licences/Certifications: - Registered Nurse license Experience/Skills: - Minimum of three years nursing experience required. - Excellent communication skills and ability to work collaboratively with all members of the health care team. - Prior experience in UR or Case Management required.
Case Management / Utilization Review
Regional Hospital of Scranton
Forecasted paid hours per shift
Forecasted hours per pay week
Community Health Systems - 2 years ago