RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus)

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

2 years experience in clinical nursing preferably in acute care Preferred

General Experience in utilization review, case management, PreCertification, or discharge planning Preferred

General Experience and knowledge of Medicare, Medicaid, and commercial insurance guidelines Preferred

General Experience and knowledge of MCG and InterQual criteria tools Preferred

Licenses

PA Registered Nurse License Required or

Multi State Compact RN License Required

This position follows a hybrid schedule of 8:00 AM to 4:30 PM and includes a rotating requirement to work every third weekend.

'406091