RN Case Management & Utilization Review Specialist

Adventist Health; San Luis Obispo (CA); Vor Ort; USD 85.000 - 121.000; Vollzeit

Zusammenfassung

Adventist Health Sierra Vista is seeking an experienced RN for discharge planning and utilization review. The role includes assessing admission status, coordinating care with patients, families, and the medical team, and ensuring payer guidelines are followed.

Ten-hour shifts with occasional weekend rotation. Familiarity with InterQual criteria and Medicare Conditions of Participation preferred. Strong computer skills required (Word, Excel, Outlook). Represented by CNA.

Qualifikationen

• Requires an Associate Degree (AS) or equivalent.
• 3–5 years of nursing in an acute care hospital.
• Experience in utilization review, discharge planning, or inpatient case management preferred.

Aufgaben

• Assess admission status using InterQual criteria.
• Coordinate discharge planning with patients, families and teams.
• Complete InterQual reviews and document progress every 72 hours.
• Assist with payer liaison and insurance authorizations.

Kenntnisse

Acute nursing

InterQual knowledge

Discharge planning

Care documentation

Ausbildung

AS Nursing

BSN preferred

Tools

Word

Excel

Outlook

Internet

Jobbeschreibung

Adventist Health Sierra Vista is seeking an experienced RN for discharge planning and utilization review. The role includes assessing admission status, coordinating care with patients, families, and the medical team, and ensuring payer guidelines are followed.

Ten-hour shifts with occasional weekend rotation. Familiarity with InterQual criteria and Medicare Conditions of Participation preferred. Strong computer skills required (Word, Excel, Outlook). Represented by CNA.