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WakeMed
Utilization Management Nurse - Patient Case ManagementWakeMed • Raleigh, NC
Utilization Management Nurse - Patient Case Management

Utilization Management Nurse - Patient Case Management

WakeMed • Raleigh, NC
30+ days ago
Job type
  • Full-time
Job description

Position Information:


Responsible for performing a comprehensive review of the medical record to assess for accuracy in the assignment of patient class (status) that is congruent with the patient's clinical condition physician intent medical necessity and current rules and regulatory requirements. Documents accurate and timely clinical reviews to support medical necessity and obtain payer authorization. Complies with current rules and regulatory requirements pertaining to utilization management. Communicates and collaborates with providers and members of the health care team to promote optimal appropriate and cost- effective utilization of resources. Identifies addresses and mitigates avoidable days whenever possible.

Experience Requirements:
3 Years Nursing - Related Area Required - And 5 Years Nursing - Related Area Preferred - And Direct Position Experience In Clinical - Case Management Or Clinical - Discharge Planning Or Accounting/Finance - Third Party Review Or Clinical - Utilization Management Preferred

Select Education Type:
Graduate Nursing Required - And Bachelor's Degree Required - And Bachelor's Degree Nursing Preferred

Licensure/Certification Requirements:
Registered Nurse Required - And Certified Case Manager Or Commission for Case Management Certification Required - Within 24 Months of Hire

Hours of Work:
7am - 7pm and every other weekend

Weekend Requirements:
Every Other

Call Requirements:
No

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Utilization Management Nurse - Patient Case Management • Raleigh, NC

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