Utilization Management RN | Discharge Planning

Thomas-Jefferson-University-; Philadelphia (Philadelphia County); On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

Medical insurance

Tuition assistance

Retirement plans

Dental and Vision insurance

Job summary

Thomas Jefferson University Hospitals, Inc. seeks an experienced RN for utilization management to determine patient status, assist in discharge planning, and coordinate with physicians and case managers.

The role requires collaboration with the Medical Necessity process and adherence to InterQual/mcg criteria across departments. Responsibilities include DRG documentation for inpatients, discharge planning, and timely communications with the care team.

Qualifications

• Bachelor’s Degree in Nursing required.
• 3 years case management, discharge planning or utilization management experience required.
• Knowledge of managed care, governmental and third party payer reimbursement.
• Proficient with InterQual and mcg criteria and its application.
• Strong interpersonal relationships.
• Ability to prioritize workload and meet deadlines.
• Knowledge of legislation and regulatory bodies affecting healthcare practices.

Responsibilities

• Interacts with co-workers, visitors, and staff per Jefferson values.
• Collaborates with the Physician Advisor and Multidisciplinary Team to facilitate Medical Necessity process.
• Applies approved utilization acuity criteria to establish appropriateness of admissions and patient status and documents findings.
• Documents initial DRG for inpatients and maintains care documentation.
• Establishes discharge plans including homecare services and post-acute facility placements.
• References cases to Physician Advisor per procedures and informs patient and Case Manager.
• Communicates discharge plan to patient, family and multidisciplinary team.

Skills

RN licensure

InterQual criteria

mcg criteria

Communication

Discharge planning

Team collaboration

Time management

Education

Bachelor's Degree in Nursing

Tools

InterQual

mcg criteria

Electronic Health Records

Job description

Thomas Jefferson University Hospitals, Inc. seeks an experienced RN for utilization management to determine patient status, assist in discharge planning, and coordinate with physicians and case managers.

The role requires collaboration with the Medical Necessity process and adherence to InterQual/mcg criteria across departments. Responsibilities include DRG documentation for inpatients, discharge planning, and timely communications with the care team.