Case Manager-RN

Job description

Employment Type: Full time Shift: Day Shift Description: Full Time Days 8-hour shifts Position Summary: -The Utilization Review ( UR ) Case Manager – Post-Acute Prior Authorization role performs Utilization Review activities and serves as the central coordinator for post ‑ acute prior authorizations (PAs) for skilled nursing, swing bed, CAH swing, acute rehab, LTACH, and other post ‑ acute levels of care. -This role drives timely authorization determinations, reduces authorization ‑ related delays, supports throughput goals, decreases avoidable inpatient days, and helps ensure efficient discharge planning. Responsibilities include PA submission and follow ‑ up , denial ‑ prevention support, external notifications, data extraction from the chart, Epic work queue tasks, supporting second IMM processes as needed, coordination with payers and post ‑ acute facilities, and assists with other appropriate administrative support for the acute care management team. Essential Functions: 1) Post ‑ Acute Prior Authorization Management (Primary Function) Centralizes, submits , monitors, and follows up on post ‑ acute prior authorizations using payer portals, phone calls, and clinical documentati...