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RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus) at Temple Health System
Philadelphia, Pennsylvania, United States -
Full Time

Start Date

Immediate

Expiry Date

26 May, 26

Salary

0.0

Posted On

25 Feb, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Utilization Review, InterQual, Case Management, Acute Care, Medical-Surgical, Utilization Management, Quality Assurance, Medical Necessity, Level of Care Determination, Patient Care

Industry

Hospitals and Health Care

Description
Utilizing InterQual and other appropriate criteria, responsible for reviewing all admissions and continued stay of patients in conformance with the established criteria set forth in the hospital's utilization management and quality assurance plan. Will determine the medical necessity for admission and continued stays for patients within department's scope of service and to meet the hospital's objectives for assuring a high quality of patient care as well as assuring the effective and efficient utilization of available health services. Identifies appropriate level of care for inpatients and outpatients requiring overnight care. Education Other Graduate of an accredited school of nursing Required Bachelor's Degree BSN Required Experience 1 year experience of recent Utilization Review in acute care or in insurance company setting. Required 1 year experience in medical-surgical setting. Required 1 year experience in working with competency utilizing InterQual criteria. Required General Experience in working with utilization review standards Required Licenses PA Registered Nurse License Required Certified Case Manager Preferred Multi State Compact RN License Required Or Schedule: Monday–Friday, 8:00 AM–4:30 PM
Responsibilities
The RN Case Manager is responsible for reviewing all patient admissions and continued stays using InterQual and other criteria to ensure conformance with the hospital's utilization management plan. This involves determining the medical necessity for care and identifying the appropriate level of care to ensure high quality and efficient utilization of health services.