Part-Time Utilization Management Nurse - Weekend Case Manager

aah; Arkansas; Vor Ort; USD 4.890.000 - 7.336.000; Teilzeit

Benefits dieser Stelle

Health benefits

PTO

Retirement plans

Educational assistance

Zusammenfassung

Advocate Health is seeking a Part-time Case Management Professional in the United States (Arkansas) for weekend coverage, with 24 hours per week. This role requires a current RN license and utilization review experience to coordinate care, authorize stays, and ensure compliance with CMS and state regulations.

Strong documentation and collaboration with payors and clinicians are essential. Bachelor’s in Nursing is required; a Master’s in business or healthcare-related field is preferred.

Qualifikationen

• Bachelor’s in Nursing from an accredited school required.
• Master's degree in business or healthcare-related field preferred.

Aufgaben

• Coordinate with healthcare team and payors to facilitate placement of patients at the appropriate level of care.
• Provide timely flow of clinical information to payors to obtain authorization of stay, complying with CMS and state/federal rules.
• Perform admission and continued stay utilization reviews to ensure medical necessity and appropriate level of care.
• Document utilization management activities timely and accurately; apply evidence-based criteria for hospital-level decisions.
• Escalate and resolve denials to secure payment; collaborate with payors and multidisciplinary team.

Jobbeschreibung

Advocate Health is seeking a Part-time Case Management Professional in the United States (Arkansas) for weekend coverage, with 24 hours per week. This role requires a current RN license and utilization review experience to coordinate care, authorize stays, and ensure compliance with CMS and state regulations.

Strong documentation and collaboration with payors and clinicians are essential. Bachelor’s in Nursing is required; a Master’s in business or healthcare-related field is preferred.