Utilization Review Case Manager

Utilization Review Nurse

Works under the supervision of the Director of Care Management. Reviews the medical record on a concurrent basis, utilizing criteria accepted and approved by the Medical Staff, for admissions and continued stay of patients requiring acute care or observation. Monitors the plan of care to ensure the efficient utilization of resources. Collaborates with the multidisciplinary team to improve clinical care, customer satisfaction, organizational and financial outcomes. Serves as a clinical expert and resource in Utilization Review and Case Management. Partners with Social Workers to refer potential candidates for Post-Acute Care services to facilitate early discharge planning and transitions of care. Responsible for reviewing hospital patient account for correct status and billing compliance. Assists with Performance Improvement monitoring and reporting activities. Performs other duties as assigned.

Education, Work Experience and Licensure:

· Graduate of an accredited School of Nursing. BSN preferred.

· Active RN license recognized by the Ohio Board of Nursing.

· A minimum of three years experience as a registered nurse in acute care for adult or pediatric patients required. Past Hospital experience in related field will be taken into consideration.

· Professional experience with case management, utilization review, or discharge planning highly desirable.

· Certification/Accreditation in Case Management required within 2 years of eligibility.