RN-Case Mgr Prof Other PRN (2102)

Bolivar Medical Center

Job Description

The Utilization Review Coordinator ensures cost effective quality care by monitoring cases in relation to established levels of care criteria, length of stay, regulatory agency and patient care guidelines. They will assist with the planning and coordination of quality care treatment by collaborating with the entire interdisciplinary team during the patients entire stay at BMC. The Utilization Review Coordinator will have a primary duty to ensure that all inpatient as well as specified outpatient services are authorized to help ensure prompt and full payment from the various insurance carriers . The Utilization Review Coordinator must stay current and knowledgeable of all certification requirements to include the Medicare and Medicaid Rules and Regulations. They will perform admission, continued stay and retro reviews as required by the various carriers and must ensure these reviews are performed on a timely basis. The Utilization Review Coordinator will be involved with the entire Case Management Department functions and requirements and will share the same goals and philosophy. They will work closely with the social worker/case manager to integrate psychosocial management of patient/family needs and assists with discharge services as requested. The Utilization Coordinator will be utilized in other areas as listed below.


Regulatory Requirements:
Current State LPN or RN Licensure.
1-2 years clinical nursing experience.
BLS required.
Language Skills:
Ability to read and communicate effectively in English.
Additional languages preferred.
Strong written and verbal skills.
Basic computer knowledge.
Current clinical knowledge.
Understanding of healthcare/HMO industry.
Knowledge of financial and/or statistical analysis.

Physical Demands:
For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

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Primary Location Mississippi-Cleveland

Schedule Per Diem/PRN

Shift Variable