Care Management Specialist
3 weeks ago
Marshall Health Network is seeking a skilled Utilization Review Specialist for our Care Management Department. The ideal candidate will exercise independent judgement and professional discretion in the practice of case management to patients.
The Utilization Review Specialist collaborates with physicians to ensure that patients are at the appropriate level of care with use of clinical based guidelines such as InterQual/MCG.
Key Responsibilities:
* Monitor continuing stay to protect solving skills to meet the needs of the patients and physicians while meeting the contractual guidelines of our payers.
* Collaborate with physicians to ensure patients are at the appropriate level of care.
* Utilize clinical based guidelines such as InterQual/MCG.
Requirements:
* Graduate of an approved school of nursing; holds and maintains current Registered Nursing License for the state of West Virginia.
* Five years nursing experience.
* Direct knowledge of care management, discharge planning and resource management.
Certifications/Skills:
* Certifications in Care Management preferred, not required.
* BLS required
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