RN Case Manager: Utilization & Care Coordination

Arkansas Heart Hospital; United States; On-site; USD 80,000 - 100,000; Full time

Job summary

Arkansas Heart Hospital is seeking a Case Manager Utilization Review to lead nursing-driven assessment, planning and evaluation of care for a designated patient load. You will optimize clinical and financial outcomes by applying UR criteria and coordinating admissions, transfers and level of care decisions.

The role requires an RN with current state licensure; BSN is preferred. Experience in cardiovascular nursing and case management is valued to support hospital processes and collaboration with

Qualifications

• Communicates effectively with patients, families, physicians, staff.
• Maintains knowledge of national standards and Joint Commission Standards.
• Uses hospital information systems correctly for documentation and communications.

Responsibilities

• Performs admission and continued stay reviews for all payers and levels of care within defined timelines.
• Applies utilization review criteria objectively for admissions, levels of care and discharge readiness.
• Coordinates admissions, transfers and changes in care level, including emergencies.
• Collaborates with attending physicians on denials and appeals processes.
• Participates in CM/UR committee activities and weekly interdisciplinary health team conferences.
• Monitors data to address over/under-utilization and to improve efficiency and reimbursement.

Skills

Communication skills

Interdisciplinary collaboration

Documentation skills

Patient education

Education

RN (required)

BSN preferred

Job description

Arkansas Heart Hospital is seeking a Case Manager Utilization Review to lead nursing-driven assessment, planning and evaluation of care for a designated patient load. You will optimize clinical and financial outcomes by applying UR criteria and coordinating admissions, transfers and level of care decisions.

The role requires an RN with current state licensure; BSN is preferred. Experience in cardiovascular nursing and case management is valued to support hospital processes and collaboration with