RN Utilization Review
RN Case Manager
At AMN Revenue Cycle Solutions, we value the role each team member plays in helping us deliver on our mission of making life better for our healthcare facilities. We take pride in providing a rich and rewarding career opportunities that enable team members to reach their highest potential.
The RN Case Manager is a non-clinical role that collaborates process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality cost-effective outcomes. The RN Case Manager works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge.
- Utilization Review and Discharge planning monitoring patient's continuum of care.
- Performs continuous assessments and evaluations to ensure patient is progressing towards desired outcomes.
- Assesses and responds to patient/family needs by coordinating efforts of other team members.
- Identifies and resolves barriers that hinder effective patient care.
- Collaborates and consults with physicians on patient's progress and discharge planning needs.
- Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity.
- Manages the process to review and, as appropriate, appeal denials received from payers.
- Coordinates the discharge planning process ensuring involvement of all members of the healthcare team. Counsels with patients and family members in decision making and in meeting psycho social needs of the patient.
- Maintains knowledge of resources and facilities available to patients and family members.
- Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions.
- Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities.
- Orients and mentors new staff members as needed.
• at least 2 years Acute Care Case Management Experience, recent experience/knowledge of utilization review, discharge planning and/or case management tools preferred.
• Prior clinical nursing experience required.
• Associate of nursing degree required
• Four-year Bachelors of Nursing degree preferred
• Graduate or professional work or advanced degree preferred
Licenses & Certifications:
• Licensed RN required
• Case Management certifications preferred (ACM, CCM, etc.)
AMN Revenue Cycle Solutions offers opportunities for learning and career development; competitive pay; and a comprehensive benefits program. We promote a diverse and inclusive workplace. Our team members have a voice in their work through surveys, pulses and town halls.