RN Utilization Review & Care Coordination Specialist

1000 Owensboro Health, Inc.; Owensboro (KY); On-site; USD 65,000 - 90,000; Full time

Job summary

Owensboro Health Regional Hospital is seeking a qualified Case Manager to facilitate cost-effective, quality patient outcomes and transitions by determining appropriate care levels and providing guidance and support to assigned patients.

The role entails collaborating with the care team, educating patients and families, and ensuring compliance with regulatory requirements. This position requires a nursing degree, active KY RN licensure, and the ability to work in a fast-paced environment.

Qualifications

• Bachelor’s degree in Nursing required upon hire.
• RN license and eligibility to practice in Kentucky required.

Responsibilities

• Assess chart and patient condition, finances, emotional needs and support systems.
• Review medical necessity and level of care using approved criteria within set timeframes.
• Provide clinical information to payers as requested within set timeframes.
• Collaborate with physicians and leadership on patients not meeting regulatory hospitalization requirements.
• Deliver regulatory letters to patients and educate about case management processes.
• Train new case managers, students and interns as needed.

Skills

Critical thinking

Decisive judgment

Stress management

Education

Bachelor’s degree in Nursing

RN license

Job description

Owensboro Health Regional Hospital is seeking a qualified Case Manager to facilitate cost-effective, quality patient outcomes and transitions by determining appropriate care levels and providing guidance and support to assigned patients.

The role entails collaborating with the care team, educating patients and families, and ensuring compliance with regulatory requirements. This position requires a nursing degree, active KY RN licensure, and the ability to work in a fast-paced environment.