Job Description:

The primary purpose of this job is to do case management as well as social services activities

• and utilization review duties. Duties & Responsibilities may include
• but not limited to: 1
• Complete chart reviews to:
• Assess medical necessity for the level of care and services provided using criteria as directed by the patient's payor sources
• Document in the UR note and complete certifications or forward information to payor's as required by payor source.
• Assist quality department in compliance with core measures.
• Improve concurrent documentation to optimize quality of patient care and accurate reimbursement.
• Participate in denial management and complete the appeals process. 2
• Assess discharge needs of patients, document in medical record, meet discharge needs, and participate in multidisciplinary team meetings. 3
• Utilize strategies to decrease re-admissions (complete risk assessments on inpatients, obtain referrals as needed, coordinate care with patient, family and doctor.

Education & Licensure:

Associates degree/Bachelor degree in Nursing

• Licensed Registered Nurse (RN)

• REQUIRED

  . ACLS and BLS certifications. Two years Case Management experience
• preferred. Med/Surg background, Knowledge of Cerner and MCG (Indicia), and Case Management experience
• preferred