Utilization & Care Management RN

Care New England; Warwick (RI); On-site; USD 85,000 - 110,000; Full time

Job summary

Care New England Health System seeks an experienced registered nurse to analyze medical records for billing accuracy and determining the appropriate level of care. The role emphasizes utilization review and resource management across hospital services.

The position involves ensuring quality care, communicating medical necessity to patients or families, and collaborating with departments to finalize discharge planning.

Qualifications

• Bachelor's degree in Nursing and at least five years of related experience.
• RN license required.

Responsibilities

• Analyze patient records for proper utilization of beds and services and accurate payment.
• Develop the hospital database for case management and severity implications.
• Analyze patient charts for quality of services rendered and intervene to assure delivery of quality care.
• Communicate to patient and/or family regarding medical necessity of hospital stay.
• Coordinate with departments to determine level of care at discharge and participate in discharge planning.
• Perform all other related duties as assigned.

Skills

Nursing knowledge

Billing/compliance

Education

Bachelor's Degree in Nursing

Job description

Care New England Health System seeks an experienced registered nurse to analyze medical records for billing accuracy and determining the appropriate level of care. The role emphasizes utilization review and resource management across hospital services.

The position involves ensuring quality care, communicating medical necessity to patients or families, and collaborating with departments to finalize discharge planning.