Care Manager

Location: WK Medical Center
Department: Care Management
Classification: Full-Time
Shift: 7:30 AM-4:00 PM
Date Posted: 12/11/2019
Description: UTILIZATION REVIEW POSITION

The primary responsibility of the utilization review nurse is to review medical records and prepare clinical appeals (when appropriate) on medical necessity, level of care, length of stay, and authorization denials for hospitalized patients.

An understanding of the severity of an array illnesses, intensity of service, and care coordination needs are key, as the nurse must integrate clinical knowledge with billing knowledge to review, evaluate, and appeal clinical denials related to the care provided to the hospitalized patient.

The utilization review nurse works with the multidisciplinary team to assess and improve the denial management, documentation, and appeals process of such findings.

This employee will work with the Case Managers to ensure that the hospital renders quality care in a cost effective manner within the reimbursement guidelines.  This employee is responsible for providing plans of care, orders, a summary, and extended stay reviews to Medicare, Medicaid, and private insurance companies requesting this on their insured patients. 
 
The Utilization Management Program promotes the appropriate allocation of hospital’s resources and quality care for each patient based upon each patient's identified needs and involvement in their care decisions.
 
 

QUALIFICATIONS:

Valid Louisiana nursing license (RN) preferred

2 to 3 years clinical experience in an acute care setting.  Utilization and/or Case Management experience desirable.

HOURS - 7:30a-4p

Willis-Knighton is an equal opportunity employer and thus, manages its employment and employee relations policies, practices and benefits without regard to age, race, sex, color, creed, religion, national origin, disability, veteran, or other protected status where otherwise qualified.