The case manager is responsible to assist in the development, planning, coordination and administrtion of the activities of Utilization Reviw. Conducts concurrent reviws of the medial record to determine appropriateness and medical necessity of admission, continued hospital stay and use of ancillary services. Assumes a leadership role within the interdisciplinary team to coordinate services through the continuum of care to achiee optimal clinical and resource outcomes. Facilitates and coordinates the discharge plan. Communicates same to all stakeholders.
Responsible for the electronic/telephonic communication between the hospital and the insurers. Obtains authorizations for the next level of care. Leads the discharge planning while communicating w/ the stakeholders. Tracks outliers and formulates plan of interventon to keep within the goals of the department.
Must have an active PA Registered Nurse license.
3-5 years of hospital clinical experience
Former case management experience preferred.