RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus)

apartment Temple Health location_onPhiladelphia, PA, US

Utilizing InterQual and other appropriate criteria, responsible for reviewing all admissions and continued stay of patients in conformance with the established criteria set forth in the hospital's utilization management and quality assurance plan. Will determine the medical necessity for admission and continued stays for patients within department's scope of service and to meet the hospital's objectives for assuring a high quality of patient care as well as assuring the effective and efficient utilization of available health services. Identifies appropriate level of care for inpatients and outpatients requiring overnight care.

Education

Other Graduate Of An Accredited School Of Nursing Required

Bachelor's Degree BSN Required

Experience

1 year experience of recent Utilization Review in acute care or in insurance company setting. Required

1 Year Experience In Medical-surgical Setting. Required

1 year experience in working with competency utilizing InterQual criteria. Required

General Experience In Working With Utilization Review Standards Required

Licenses

PA Registered Nurse License Required

Certified Case Manager Preferred

Multi State Compact RN License Required Or

Schedule: Monday–Friday, 8:00 AM–4:30 PM

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