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Utilization Management Nurse - Patient Case Management
OverviewResponsible for performing a comprehensive review of the medical record to assess for accuracy in the assignment of patient class (status) that is congruent with the patient's clinical condition, physician intent, medical necessity and current rules and regulatory requirements. Documents accurate and timely clinical reviews to support medical necessity and obtain payer authorization. Complies with current rules and regulatory requirements pertaining to utilization management. Communicates and collaborates with providers and members of the health care team to promote optimal, appropriate, and cost- effective utilization of resources. Identifies, addresses, and mitigates avoidable days whenever possible. Department Description
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