About the job
Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. Combines clinical, business, regulatory knowledge, and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments from admission through discharge, problem identification and education, facilitates the quality of health care delivery in the most cost effective and efficient manner. Utilizes best practice workflows, evidence-based screening criteria and critical thinking to maximize reimbursement.
Education And Experience
- Bachelor of Science in Nursing, required.
- Minimum 3-5 years of clinical experience preferred.
- Previous utilization management or case management experience preferred.
- Knowledge of outside regulatory agencies that interface with the institution.
Additional Information
- Organization: Corporate Services
- Department: Central Utilization Mgt
- Shift: Day Job
- Union Code: Not Applicable