Utilization Review RN - Case Management for Outcomes

Palmetto General Hospital; Florida; On-site; USD 65,000 - 90,000; Full time

Job summary

Palmetto General Hospital in Florida is seeking a Case Management RN to perform activities ensuring medical necessity of admissions and the appropriateness of continued stay using Interqual criteria. The role involves collaborating with patients, families and health care professionals to develop and monitor care plans.

Responsibilities include evaluating daily patient progress, adjusting plans to improve outcomes, and maintaining confidential communications with physicians and the

Qualifications

• Must be able to use the medical record for Interqual reviews.
• Three or more years of acute care hospital experience preferred.
• Fluent in written and spoken English.

Responsibilities

• Perform Case Management activities to ensure medical necessity of admissions and appropriate continued stay using Interqual guidelines.
• Monitor resource utilization across patients and coordinate care plans with patients, families, and health care professionals.
• Evaluate daily patient progress and adjust care plans to improve outcomes.
• Maintain confidential communications with physicians and multi-disciplinary staff.

Skills

Communication

English Proficiency

Acute Care Experience

Interqual Knowledge

Medical Record Review

Outlook/EMR Proficiency

Medical-Surgical/ICU Experience

Job description

Palmetto General Hospital in Florida is seeking a Case Management RN to perform activities ensuring medical necessity of admissions and the appropriateness of continued stay using Interqual criteria. The role involves collaborating with patients, families and health care professionals to develop and monitor care plans.

Responsibilities include evaluating daily patient progress, adjusting plans to improve outcomes, and maintaining confidential communications with physicians and the