Utilization Review Case Manager - FT Days
$55.56 - $85.96 per hourTorrance Memorial
Utilization Review Case Manager
Under general supervision, the Utilization Review Case Manager (UR CM) performs review of patient charts as defined by the Hospital's Utilization Review Plan. The UR CM validates the patient's admission status and level of care to be at the most appropriate based on nationally accepted admission criteria. The UR CM uses medical necessity screening tools, such as MCG criteria to complete initial and continued stay reviews in determining appropriate admission and continued stay status and level of patient care. The UR CM secures authorization for the patient's clinical services through collaboration and communication with payers as required. The UR CM follows the UR process as defined in the Utilization Review Plan in accordance with the CMS condition of Participation for Utilization Review.
Core Competencies
Adheres to policies, procedures, and standards of practice to deliver safe and optimal care. Complies with Joint Commission's national patient safety goals. Complies with organizational quality dashboard/benchmarking goals. Maintains regulatory compliance consistent with quality standards and ethical obligations of the profession. Participates in activities in alignment with the Magnet Model. Participates in organizational committees, task forces and/or projects including presentation of project reports, committee recommendations, and task force activities at the unit level. Participates in Peer Review. Participates in professional development activities. Provides patient and family education throughout the care of patient. Performs as a preceptor in an active and engaged manner. Provides age specific and culturally competent discharge planning to all patients.
Department Specific Competencies
Attends denial management committee. Identifies and monitors Observation cases on a daily basis. Performs retrospective reviews. Reviews all commercial accounts daily or as per contract or payer expectation. Collaborates with RN Case Managers and the Physician Advisors to facilitate the peer to peer process in order to mitigate potential denials. Demonstrates independent judgment, autonomy, initiative, time management and organizational skills and the ability to prioritize projects/functions in a busy work environment.
Education
Degree - Program
Bachelors - Nursing
Additional Information
Experience
Number of Years Experience - Type of Experience
1 - Acute hospital case management, Health Plan Utilization Review
2 - Clinical experience in an acute care facility
Additional Information
N/A
License / Certification Requirements
Registered Nurse License
Compensation Range:$55.56-85.96 / Hour
Torrance Memorial$46.07 - $67.73 per hour
...Coordinator (RN) - Subacute/FT/Days Job Category: Registered Nurse... ...wound care techniques, self-management strategies, and signs of... ...patients and family members. Utilizes white boards for patient communication... ...further information, please review the Know Your Rights notice...SuggestedHourly payFull timeShift work- ...position integrates functions typically considered to be case management, care coordination, and/or utilization management, and discharge planning assessment.... ...case management, care coordination, and/or utilization review Demonstrate the ability in collaborating with...SuggestedMonday to Friday
- ...position integrates functions typically considered to be case management, care coordination and utilization management, and discharge planning assessment.... ...case management, care coordination, and/or utilization review Demonstrate the ability in collaborating with physicians...Suggested
$47.2 - $63.45 per hour
...for the quality and resource management of all patients that are admitted... ...admission and concurrent review of the medical record for the... ...least one year experience in case management, discharge planning... ...Employment Status Full Time Shift Days Equal Employment Opportunity...SuggestedFull timePart timeWork experience placementLocal areaShift work- ...supervision of the CM Director the nurse case manager manages clinical resource utilization and documentation affecting... ...Chance Act. Essential Functions Reviews clinical information daily on each... ...timely manner, preventing avoidable days. Attends daily HPIRounds to...SuggestedFull timeShift workDay shift
- ...Case Manager Qualifications for Case Manager: The Case Manager is... ...Partners with medical staff, utilizes scientific evidence for best... ...service, possible avoidable days, provider preventable conditions... ...performance through the review of completed work assignments...Temporary workShift work
Care Navigators On Demand
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