Network Health has an exciting opportunity for a RN to join their Medicare Utilization Management team.
The Medicare Inpatient Facility Coordinator role is a full-time, day shift position.
Responsible for inpatient utilization management process including review/data collection from inpatient providers, application of review criteria, and in benefit and medical necessity determinations. Makes recommendations to team for care management opportunities. Collaborates with and provides feedback to providers regarding utilization management and in particular, Skilled Nursing Facilities via record review, member visits and care managing a caseload of members.
Advocates for and supports Medicare member care management needs with an emphasis on empowering members and their caregivers to achieve improved outcomes. Effectively manages care and resources based upon evidence based guidelines and approved measures.
Graduation from an accredited school of professional nursing, Bachelor of Science in Nursing preferred.
Current registered nurse licensure in the State of Wisconsin .
Minimum of four years clinical health care experience as a Registered Nurse (RN). At least one year Long Term Care experience required.
Experience working with insurance, managed care and utilization management preferred.
Excellent communication and decision-making skill
Normal Weekly Hours
Staff Registered Nurses
Ministry Health Care - 16 months ago