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The RN Float Case Manager and Utilization Review Nurse provides coverage for an RN Case Manager or RN Utilization Review Nurse. The RN Float Case Manager and Utilization Review Nurse is assigned to function in the role of either a RN Case Manager or RN Utilization Review Nurse, as provided below. When functioning in the role of a RN Case Manager: In collaboration with the interdisciplinary team, provides care coordination services evaluating options and services required to meet an individual's health care needs to promote cost-effective, quality outcomes. Serves as a consultant to members of the health care team in the management of specific patient populations. The RN case manager role integrates the functions of utilization management, quality management, discharge planning assessment, and coordination of post-hospital care services, including transfers to an alternative level of care. When functioning in the role of a RN Utilization Review Nurse: The RN Utilization Management Specialist coordinates communication with admitting financial counselors, case management team, providers, patient financial services, and payers to ensure all services provided by the hospital are authorized by appropriate payer. The RN Utilization Management Specialist confers and reviews with physicians on medical admitting information to assess medical necessity and uses evidence-based criteria to consider the anticipated length of stay, level of care, intensity of service to support access to services. The RN Utilization Management Specialist facilitates timely transmission of admission, concurrent and discharge reviews to the appropriate payer to ensure all days are authorized and documented. Clinical reviews and continued stay authorizations will be documented in the appropriate electronic system.
Essential Duties:
Required Qualifications:
Preferred Qualifications:
Required Licenses/Certifications:
Full Time
$96k-115k (estimate)
11/16/2023
04/30/2024
keckmedicine.org
Los Angeles, CA
1,000 - 3,000