Provides utilization review and discharge planning for a patient population, coordinates safe care transitions, communicates with payers to reduce denials and readmissions, and meets assigned goals and regulatory requirements.
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
- Utilization Review
- Discharge planning
- Readmission Reduction Participation
- Payer Communication and denial reduction
- Completes assigned goals.
Specifications
Experience
Minimum Required
- RN with at least one (1) year of clinical experience
Preferred/Desired
- RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Education
Minimum Required
- Diploma or Associate Degree in Nursing
Preferred/Desired
- BSN or MSN
Training
Minimum Required
Preferred/Desired
- Certified Case Manager
Special Skills
- .
Minimum Required
- Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Preferred/Desired
- Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Licensure
- RN
Minimum Required
- RN
Preferred/Desired
- RN;CCM;ACM
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