The UR RN Case Manager facilitates effective utilization of appropriate health services via collaboration with physicians, nurses, social workers, other healthcare team members (ie – financial counselors), and payers to coordinate health care services that optimize clinical outcomes and patient satisfaction with services from pre-admission through post-discharge transition for this select patient population. This position performs pre-admission, concurrent admission, and retrospective clinical review of medical necessity to determine the appropriate level of care and resource utilization. The UR RN Case Manager is responsible for ensuring implementation and monitoring of compliant documentation strategies by ensuring procedure(s) noted in the pre-admission review was/were completed and the physician’s orders are present, accurate, and signed prior to patient being discharged; or updated as needed once operative note has been reviewed.
MINIMUM QUALIFICATIONS AND REQUIREMENTS
Licenses and Certifications Required
Current or temporary RN license in ND or compact RN licensure
Following two years of work as a Case Manager, it's preferred that the incumbent be enrolled and actively working on obtaining certification in Case Management.
BLS certification preferred
Educational Requirements
BSN preferred
Experience Requirements
Must have three (3) years of recent experience in a clinical area
Prior Case Management/Utilization Review experience preferred
Special Skills or Training Requirements
Demonstrated evidence of dependability, diplomacy, and initiative
Demonstrated strong communication and interpersonal skills with all levels of internal and external customers, including but not limited to medical staff, patients and families, clinical personnel, other Case Managers, support and technical staff, outside agencies, third party payers, and members of the community
Basic understanding of reimbursement issues, denials, and DRGs
Knowledge of clinical criteria for medical necessity
Personal computer skills using e-mail, word processing, etc.
