Senior RN: Post-Acute Care Utilization Reviewer

CareSource; Dayton (OH); Ibrido; USD 63.000 - 100.000; Tempo pieno

Vantaggi offerti da questo lavoro

Bonus program

Descrizione del lavoro

CareSource in Dayton, OH seeks a Clinical Care Reviewer II - Post-Acute to conduct medical necessity reviews for SNF, NF, LTACH and IRF settings, supporting discharge planning and care coordination for members.

The role requires an RN with at least 3 years of clinical experience and knowledge of state/federal regulations. It involves interdepartmental collaboration, weekend/holiday coverage, and focus on cost-effective, quality care.

Competenze

• RN license required and active in state of practice
• 3 years of clinical experience required
• Utilization Management/Utilization Review experience preferred

Mansioni

• Conduct prospective, concurrent, and retrospective review of post-acute admissions and related services according to established processes.
• Complete clinical reviews for new and continued stays in post-acute services and assist in timely discharges.
• Refer cases to Medical Directors when criteria are not met or case conference is needed.
• Document discharge planning needs to support coordinated care and communicate with providers and care managers.

Conoscenze

Attention to detail

Communication skills

Time management

Independent work

Teamwork

Data entry

Formazione

Registered Nurse (RN) degree

Strumenti

Microsoft Outlook

Microsoft Word

Microsoft Excel

Descrizione del lavoro

CareSource in Dayton, OH seeks a Clinical Care Reviewer II - Post-Acute to conduct medical necessity reviews for SNF, NF, LTACH and IRF settings, supporting discharge planning and care coordination for members.

The role requires an RN with at least 3 years of clinical experience and knowledge of state/federal regulations. It involves interdepartmental collaboration, weekend/holiday coverage, and focus on cost-effective, quality care.