RN Utilization Case Manager

Job Summary

To support the Utilization Management Program, the full-time remote RN Utilization Case Manager will implement guidelines to assess inpatient care appropriateness and ensure compliance with payer requirements.

Key responsibilities

• Determine appropriateness for inpatient level of care or observation services using medical necessity guidelines
• Maintain knowledge of State and National healthcare trends, as well as JCAHO and CMS guidelines
• Apply various payer rules and regulations to support the hospital's Utilization Management Program Plan

Required qualifications

• Bachelor's degree required; Master's degree preferred
• Current RN licensure
• Three years of Case Management and/or Utilization Management experience