RN Case Manager: Utilization Review & Care Coordination

Augusta Health; Fishersville (VA); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Healthcare Benefits

Generous paid time off

Retirement savings plan

Free onsite parking

24/7 armed security

Job summary

Augusta Health in Fishersville, VA seeks an Utilization Review RN Case Manager to determine patient status by applying medical necessity criteria and regulatory standards. You will collaborate with admitting providers and the Utilization Management Physician Advisor to ensure compliant patient status and appropriate level of care.

Key responsibilities include participating in multidisciplinary rounds, securing reimbursement from payers, and ensuring timely submission of clinical information.

Qualifications

• Regulatory and standards knowledge for utilization review.
• Proficient with EHR systems and medical necessity criteria.
• Strong verbal and written communication across disciplines.

Responsibilities

• Determine patient status using medical necessity criteria and regulatory requirements.

Skills

Regulatory knowledge

Communication skills

Organizational skills

Problem solving

EHR proficiency

Education

Bachelor of Science in Nursing

ADN + 3 years RN experience

Tools

Microsoft Office

Job description

Augusta Health in Fishersville, VA seeks an Utilization Review RN Case Manager to determine patient status by applying medical necessity criteria and regulatory standards. You will collaborate with admitting providers and the Utilization Management Physician Advisor to ensure compliant patient status and appropriate level of care.

Key responsibilities include participating in multidisciplinary rounds, securing reimbursement from payers, and ensuring timely submission of clinical information.