You haven't searched anything yet.
Duration: 13
Position Title: RN-Case Management (Utilization Review)
Position Description: Utilization Review Nurse II represents the fully experienced level in utilization review and discharge planning activities Obtains and evaluates medical records for in-patient admissions to determine if required documentation is present. Obtains appropriate records as required by payor agencies and initiates Physician Advisories as necessary for unwarranted admissions. Conducts on-going reviews and discusses care changes with attending physicians and others. Formulates and documents discharge plans. Provides on-going consultation and coordination with multiple services within the hospital to ensure efficient use of hospital resources Identifies pay source problems and provides intervention for appropriate referrals Coordinates with admitting office to avoid inappropriate admissions. Coordinates with clinic areas in scheduling specialized tests with other health care providers, assessing pay source and authorizing payment under Medically Indigent Adult program as necessary. Reviews and approves surgery schedule to ensure elective procedures are authorized. Coordinates with correctional facilities to determine appropriate use of elective procedures, durable medical goods and other services. Answer questions from providers regarding reimbursement, prior authorization and other documentation requirements. Learns the documentation requirements of payor sources to Amergisize reimbursement to the hospital Keeps informed of patient disease processes and treatment modalities. Level II Teaches providers the documentation requirements of payor sources to Amergisize reimbursement to the hospital. Level II May assist in training Utilization Review Nurse I's. Knowledge of payor source documentation requirements and governmental regulations affecting reimbursement; knowledge of acute care nursing principles, methods and commonly used procedures; knowledge of common patient disease processes and the usual methods for treating them; knowledge of medical terminology, hospital routine and commonly used equipment; knowledge of acute hospital organization and the interrelationships of various clinical and diagnostic services Ability to effectively evaluate the medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans; ability to assess and judge the clinical performance of physicians and other health professionals; ability to communicate documentation needs in an effective and tactful manner that promotes cooperation; ability to teach co-workers what is needed and required in the medical record for reimbursement and audit purposes; ability to gather and analyze data and prepare reports and recommendations based thereon; ability to get along with physicians, other health providers, outside payor sources and the general public. Performs other job related duties as assigned.
Benefits
At Amergis, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
Competitive pay & weekly paychecks
Health, dental, vision, and life insurance
401(k) savings plan
Awards and recognition programs
*Benefit eligibility is dependent on employment status.
About Amergis
Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions.
Amergis is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
Full Time
$91k-113k (estimate)
06/24/2024
07/13/2024
The following is the career advancement route for RN Case manager positions, which can be used as a reference in future career path planning. As a RN Case manager, it can be promoted into senior positions as a Case Management Director that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary RN Case manager. You can explore the career advancement for a RN Case manager below and select your interested title to get hiring information.
If you are interested in becoming a RN Case Manager, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a RN Case Manager for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on RN Case Manager job description and responsibilities
Case Managers act as patient advocates and make sure the needs of the patient are met effectively and efficiently.
12/13/2021: Burlington, VT
Case Managers generally work with patients that have chronic health conditions such as diabetes, heart disease, seizure disorders, and COPD.
02/20/2022: Altus, OK
The Case Manager RN reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation s
01/12/2022: Rochester, NY
Prepares all required documentation of case work activities as appropriate.
01/28/2022: Lexington, KY
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on RN Case Manager jobs
Before becoming an RN case manager, a nurse would be expected to earn some clinical experience.
01/18/2022: Concord, NH
Graduate from an Accredited Nursing Program.
01/10/2022: Albany, NY
Gain Experience Working as a Nurse.
01/10/2022: Worcester, MA
They should be familiar with emerging professional and technical aspects and have RN case management experience.
01/27/2022: Santa Rosa, CA
Step 3: View the best colleges and universities for RN Case Manager.