Registered Nurse - Utilization Management - Full Time (varied hours) - Jefferson

Job description

Job Details Performs utilization management functions, applying medical necessity criteria to determine the appropriate patient status. Performs denial and appeal activities for inpatient hospital care. Refers cases to the Physician Advisor per departmental procedures. Works collaboratively with members of the Case Management Departments and healthcare team to ensure open lines of communication to ensure optimal outcomes and patient care. Job Description: - interacts with co-workers, visitors, and other staff consistent with the values of Jefferson. - Collaborates with the Physician Advisor and members of the Multidisciplinary Team to facilitate the Case Management Condition 44 process. - Applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards. - Performs appeal process in coordination with specific third party payor format, protocols, and timelines. Work Shift: Workday Evening (United States of America) Worker Sub Type: Regular Employee Entity: Jefferson Health Northeast Primary Location Address 10800 Knights Road, Philadelphia, Pennsylvania, United States of America Nationally...