About the job
General Summary
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/Experience Required
- Registered Nurse required.
- Minimum 3-5 years of clinical experience required.
- Bachelor of Science Nursing required OR four (4) years Case Management/ Appeal/Utilization Management experience in lieu of bachelor’s degree.
Certifications/Licensures Required
- Registered Nurse with a valid, unrestricted State of Michigan License.
Additional Information
- Organization: Corporate Services
- Department: Ascension Central Util Mgt
- Shift: Day Job
- Union Code: Not Applicable