Registered Nurse Case Manager

Utilization Management NurseUtilizing InterQual and other appropriate criteria, responsible for reviewing all admissions and continued stay of patients in conformance with the established criteria set forth in the hospital's utilization management and quality assurance plan. Will determine the medical necessity for admission and continued stays for patients within department's scope of service and to meet the hospital's objectives for assuring a high quality of patient care as well as assuring the effective and efficient utilization of available health services. Identifies appropriate level of care for inpatients and outpatients requiring overnight care.EducationOther Graduate of an accredited school of nursing RequiredBachelor's Degree BSN RequiredExperience2 years experience in clinical nursing preferably in acute care PreferredGeneral Experience in utilization review, case management, PreCertification, or discharge planning PreferredGeneral Experience and knowledge of Medicare, Medicaid, and commercial insurance guidelines PreferredGeneral Experience and knowledge of MCG and InterQual criteria tools PreferredLicensesPA Registered Nurse License Required orMulti State Compact RN License RequiredThis position follows a hybrid schedule of 8:00 AM to 4:30 PM and includes a rotating requirement to work every third weekend.