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Job Summary: 

The Utilization Review Case Manager validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria. The UR Case Manager uses medical necessity screening tools, such as InterQual or MCG criteria, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient's expected length of stay. The UR Case Manager secures authorization for the patient's clinical services through timely collaboration and communication with payers as required. The UR Case Manager follows the UR process as defined in the Utilization Review Plan in accordance with the CMS Conditions of Participation for Utilization Review.
 

Educational Requirements:

Assoc. Degree/College Diploma - Graduate of an accredited nursing program - Minimum required
Bachelor's Degree Nursing - perferred

Licenses:

RN State License - required
Basic Life Support (BLS) - required

Experience:

3 years In acute nursing - required
2 years Case Management - preferred

Physical Demands:

Lifting, standing, walking, sitting, typing, repetitive motions, reaching