Utilization Review Case Manager - FT Days

Core Competencies

• Adheres to policies, procedures, and standards of practice to deliver safe and optimal care
  
  
• Complies with Joint Commission’s national patient safety goals
  
  
• Complies with organizational quality dashboard/benchmarking goals
  
  
• Maintains regulatory compliance consistent with quality standards and ethical obligations of the profession
  
  
• Participates in activities in alignment with the Magnet Model
  
  
• Participates in organizational committees, task forces and/or projects including presentation of project reports, committee recommendations, and task force activities at the unit level.
  
  
• Participates in Peer Review
  
  
• Participates in professional development activities
  
  
• Provides patient and family education throughout the care of patient
  
  
• Performs as a preceptor in an active and engaged manner
  
  
• Provides age specific and culturally competent discharge planning to all patients.
  
  

Department Specific Competencies

• Attends denial management committee.
  
  
• Identifies and monitors Observation cases on a daily basis.
  
  
• Performs retrospective reviews.
  
  
• Reviews all commercial accounts daily or as per contract or payer expectation
  
  
• Collaborates with RN Case Managers and the Physician Advisors to facilitate the peer to peer process in order to mitigate potential denials
  
  
• Demonstrates independent judgment, autonomy, initiative, time management and organizational skills and the ability to prioritize projects/functions in a busy work environment.
  
  

Education

Experience

License / Certification Requirements

Compensation Range: 

$55.56-85.96 / Hour