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Case Manager

2 months ago


Batesville, Arkansas, United States White River Medical Center (Health System) Full time

Job Summary:

The Utilization Review Nurse will play a critical role in ensuring that patients receive the most appropriate care by reviewing physician orders, documentation, and test results. Utilizing evidence-based tools and critical thinking skills, this nurse will provide recommendations and guidance to providers to develop a plan of care that is based on medical necessity. This role requires strong communication and organizational skills to effectively manage a high-volume caseload and respond to rapidly changing priorities.

Key Responsibilities:

  • Perform admission reviews using MCG/Indicia Care Guidelines to facilitate medical necessity.
  • Identify opportunities for performance improvement and communicate them to the healthcare team.
  • Monitor patients for medical necessity and take necessary action to include issuing ABNs or HINNs and appropriately document.
  • Assist in discharge planning and provide resources and plans from the ED as needed.
  • Perform other duties as assigned by supervision.

Requirements:

  • Education: RN licensure required (Bachelor's preferred). BLS required.
  • Training and Experience: 3-5 years clinical experience required.
  • Job Knowledge: Knowledge of Conditions of Participation for Utilization Review, effective problem-solving techniques, and excellent oral and written communication skills.

Essentials:

  • Must be able to report to work fit for duty and free of any adverse effects of illegal drugs, medical marijuana, prescription medication, and/or alcohol.
  • Must be able to effectively communicate both orally and in writing with other individuals.
  • Must be able to work independently, anticipate and organize workflow, prioritize, and follow through on responsibilities.

Physical Demands:

Sitting, standing, walking, and lifting will occur for the majority of the shift. Must be able to lift 20 pounds. Must be able to sit/stand for extended periods of time. Fine motor skills. Visual acuity. Depth perception.