Utilization Mgmt RN

Overview

The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This roles monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensures that the patient's payer has the clinical information with which to authorize an acute hospital stay and the continued stay services to include covered days and associated services.

Responsibilities

The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This roles monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensures that the patient's payer has the clinical information with which to authorize an acute hospital stay and the continued stay services to include covered days and associated services.

Qualifications

Education

• Graduate of an accredited nursing school Required
• Bachelor’s Degree of Science in Nursing Preferred
• Master’s degree Preferred

Work Experience

• 2 years of experience in an acute, post-acute or payer setting Required
• 3 years of utilization review or care management experience Preferred

Licenses and Certifications

• RN - Registered Nurse - Georgia State Licensure and/or NLC/eNCL Multistate Licensure Required

Business Unit : Company Name

Piedmont Healthcare Corporate