Utilization Management RN: Care Coordination Leader

jeffersonhealth; Philadelphia (Philadelphia County); On-site; USD 85,000 - 110,000; Full time

Job summary

Jefferson Health in Philadelphia is seeking a Registered Nurse for utilization management to apply medical necessity criteria and determine patient status. You will assist in discharge planning to other levels of care and collaborate with the Case Management team to ensure optimal patient outcomes.

You will refer cases to the Physician Advisor, document findings in the EHR, and participate in multidisciplinary rounds.

Qualifications

• RN with nursing degree and current licensure.
• Experience in case management or discharge planning.
• Knowledge of medical necessity guidelines and payer policies.

Responsibilities

• Apply medical necessity criteria to determine patient status.
• Collaborate with Physician Advisor and multidisciplinary team.
• Document findings in electronic health records per policy.
• Coordinate discharge planning and post-acute care.
• Refer complex cases for review per procedures.

Skills

InterQual and mcg criteria proficiency

Strong interpersonal skills

Ability to prioritize workload

Education

Bachelor's Degree in Nursing

Tools

Electronic Health Records (EHR)

Job description

Jefferson Health in Philadelphia is seeking a Registered Nurse for utilization management to apply medical necessity criteria and determine patient status. You will assist in discharge planning to other levels of care and collaborate with the Case Management team to ensure optimal patient outcomes.

You will refer cases to the Physician Advisor, document findings in the EHR, and participate in multidisciplinary rounds.