Case Manager-RN

Job description

Department: UHC: Managed Care Job Summary: The RN-Case Manager is responsible for utilization management and inpatient care management in a telephonic and/or onsite care management position; performs reviews of inpatient and outpatient services to determine medical appropriateness following evaluation of medical guidelines and benefit determination; focuses on changing from retrospective, episodic case management to a prospective system of health maintenance, disease prevention and complex case management. Through multidisciplinary collaboration, care is individualized to enhance achievement of mutually set goals and assure effective and efficient use of resources within fiscal realities. Serves as the link between the patient in the community and the primary care physician to promote seamless, quality care that enhances quality of life. The Case Manager-RN will participate in on-call rotation after-hours and/or on weekends as needed to meet contractual obligations and provide decision support for managed care issues. Performs other duties as needed. Education and Experience: High School Diploma or GED required. Bachelor's Degree in Nursing preferred. Minimum three years of experie...