RN Utilization Management - Day Shift

Job description

Job Details Registered Nurse (RN) - Utilization Management FT Day Shift (Hrs.: 8a-4:30p): Newark, DE: ChristianaCare Hospital in Newark, DE, is seeking a Utilization Management Nurse (RN) with experience with insurance providers such as Aetna and Cigna, along with a background in an acute care hospital. PRIMARY FUNCTION: Responsible for ensuring the delivery of efficient and effective health care while evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan. UTILIZATION MANAGEMENT: - Performs admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission. - Reviews the admission assessment and collaborates with primary nurse and other health care providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes. - Manages observation level of care and works with the attending physician and/or clinical provider caring for the patient to ensure observation status does not e...