Case Manager, RN- Utilization Review

Education Qualifications

• Associate’s Degree Nursing

Licenses and Certifications

• Registered Nurse

Experience Qualifications

• Three (3) years as a practicing RN in an acute care setting and least two (2) years’ experience as a case managerHMO/Managed Care/Medicare/Medicaid experience

Skills and Abilities

• Monitor and manage all inpatient hospital admissions with the goal of achieving cost- effective patient care.
• Identifies when those situations where criteria is not met for admission and discuss issues with the attending physician
• Utilize clinical skills, chart review, physician communication and clinical screening tool and utilize peer review as necessary.
• Identify when those situations where criteria is not met for admission and discuss issues with the attending physician, refer all appropriate cases to the ACMO or Physician Advisory Service.
• Follow established policies, procedures and professional guidelines while working closely with Resource Center Associates, Care Coordinators, Nursing and Providers to obtain clinical information to justify proposed services and care; establish strong relationships with Managed Care Organizations to enhance the ability to obtain authorizations for services
• Liaises with the manager and reports all situations requiring management intervention
• Will perform job functions in accordance with mission, vision and values of Tampa General Hospital.