2 utilization review rn jobs found

Overview Utilization management is the analysis of the medical necessity, acute care appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate, but ensures that an authorization for services is obtained from payer, if required, and that documentation supports the care delivered in such a way that minimizes the risk of denials after discharge. Qualifications Required Education: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse Preferred Education: Bachelors Science Nursing or higher Required Experience: 2 years previous nursing experience Preferred Experience: Utilization Review or Case Management experience Required License/Registration/Certification:...

Overview The Case Manager is responsible to assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning. Including but not limited to daily review of medical records to determine appropriateness and medical necessity of admission, continued hospital stay and use of ancillary services. Responsibilities Accurately identifies through chart review of SI/IS for admit and continued stay.  Competently coordinates the overall discharges planning and social services function ensuring compliance with federal and state laws and Joint Commission of Accreditation of Hospital. Successfully ensures patients receive recommended follow-up services. Appropriately maintains a liaison with community agencies offering services to discharge patients. Professionally maintains rapport with physicians, co-workers, representatives of other organizations, and departments....