Utilization Review/Case Manager, Full-Time

Position Summary:

Reviews and abstracts data from Medical Records. Ensures completion and accuracy of key nursing and physician documentation in the Medical Record. Assures accuracy of Arkansas Medicaid Log and filing of insurance letters of certifications and denials. Responsible for concurrently reviewing and coordinates all inpatient stays for the appropriateness of admission and continued stay (according to intensity of service and severity of illness criteria). Assists with issuing Medicare denial letters when necessary. Responsible for chart abstraction studies for certain payer groups. Assist with delivery of important messages from Medicare. Facilitates D/C planning efforts through early identification of high risk patients. Facilitates communications and continuity of care between reference agencies and hospital. To assess the patient's needs and desires regarding quality of life following hospitalization.

Required Education/Training/Experience:

A minimal of a Licensed Practical Nurse with computer skills a must. Clinical knowledge in the review of patient's records. A minimal of two years nursing experience.