Pre-employment modules may be required for this role. Please upload any certifications or health documents you have to your profile to expedite your on-boarding process.

Additional Details:

Required Skills/Experience:

• At least one (1) year of experience must be on a medical/surgical ward or unit.
• One (1) year of utilization review/discharge planning experience in an acute care hospital, OR Two (2) years of experience as a Case Manager in an alternate medical setting such as a clinic or physician’s office performing utilization review or discharge planning.

Required Credentials:

• Highest level of education as stated on the resume.

Unit Details:

• Obtains and evaluates medical records for inpatient admissions to determine if required documentation is present.
• Conducts ongoing reviews, discusses care changes with attending physicians and others, and formulates and documents discharge plans.
• Provides ongoing consultation and coordination with multiple services within the hospital to support efficient use of hospital resources and appropriate referrals.
• Coordinates with admitting, clinic areas, and correctional facilities regarding admissions, specialized tests, elective procedures, durable medical goods, and other services.
• Reviews and approves surgery schedules to ensure elective procedures are authorized.
• Answers provider questions regarding reimbursement, prior authorization, and documentation requirements, and teaches providers documentation requirements of payor sources to maximize reimbursement.
• May assist in training Utilization Review Nurse I workers.