Case Manager - Utilization Review RN
Under the general direction of the Director of Behavioral Health, the Case Manager – Utilization Review RN provides clinically based case management and utilization review services to support the delivery of high-quality, cost-effective patient care. The RN is responsible for concurrent utilization review, medical necessity determination, denial prevention, discharge planning, care coordination, and resource management across the continuum of care.
The Case Manager – Utilization Review RN collaborates with physicians, interdisciplinary team members, physician advisors, social workers, revenue cycle staff, and third-party payers to ensure appropriate utilization of hospital resources, regulatory compliance, optimal reimbursement, and safe patient transitions.
Community First Medical Center offers benefits to all its full-time and part-time employees:
- United Healthcare Medical PPO/HMO/HSA Plans, premiums as low as $50.00/full time, $85.00/Part Time
- Met Life Dental and Vision
- Paid Time Off (PTO) with annual accruals up to 168 hrs./year
- Six paid holidays
- Company Paid Life insurance and Short-term Disability
- 401(k) after 90 days
- Continuing Education reimbursement and 2 days paid off separate from PTO
- Free Parking Garage
- Internal Growth Opportunities