Utilization Mgmt Case Mgr PRN
Job ID: 422837
Category: Nursing Services
Location: Sarasota, FL
Department: Integrated Case Management
Facility: Sarasota Memorial Hospital
The Utilization Management RN (UM RNCM) utilizes professional nursing skills to assess patient and family scenarios for a clinically appropriate level of care. The UMRNCM maintains a strong knowledge base of evidence based clinical criteria (InterQual) and adeptly identifies pertinent clinical information that will support admission and continued stay hospitalization. When potential denials for payment or down skilling arise, the UMRNCM collaborates with the floor ICM staff, Revenue Cycle, the involved physicians and the Physician Advisors (PA) as needed to attain an appropriate transition for the patient or effectively over turn the denial. UMRNCM interact extensively with clinical staff throughout the hospital, other ICM staff, physicians, insurers and hospital financial staff in order to achieve appropriate authorizations and to avoid denials of payment. The UMRNCM collaborates with other ICM staff to evaluate opportunities to optimize utilization and reimbursement across populations of patients to meet organizational strategic objectives. The UMRNCM acts as a mentor/preceptor for new staff.
– Require graduation from an accredited school of nursing.
– Require a minimum of one (1) year of clinical practice in an acute care hospital.
– Require basic experience using PC/computer (word processing minimum).
– Require bachelor degree in nursing or health care administration or related field. Diploma/associate degree in nursing with a Case Management Certification (CCM or ACM) may substitute for bachelor degree.
– Prefer one (1) year of Utilization Review or Case Management experience.
– Prefer experience with Internet, including e-mail and calendar.
– Prefer previous experience with hospital information systems (order entry, results reporting)
– Prefer certification in CCM or ACM.
Bachelor of Science Nursing