Job Title: Utilization Review RN, Care Manager
Job Summary:
The Utilization Review RN, Care Manager is responsible for reviewing and evaluating patient care plans to ensure that they are medically necessary and cost-effective. They work closely with healthcare providers, insurers, and patients to facilitate efficient and high-quality care delivery.
Responsibilities and Duties:
- Review patient medical records and treatment plans to determine appropriateness and necessity of care
- Collaborate with healthcare providers to ensure that care plans meet medical guidelines and standards
- Assist with discharge planning and coordination of post-discharge care
- Communicate with insurance companies to obtain authorization for medical procedures and treatments
- Educate patients and their families on healthcare options and resources
- Monitor and track patient outcomes and quality of care
- Participate in case conferences and care team meetings to optimize patient care
Qualifications and Skills:
- Valid RN license
- Bachelor's degree in Nursing (preferred)
- Minimum of 2 years of clinical experience
- Strong communication and interpersonal skills
- Ability to work independently and as part of a team
- Knowledge of healthcare regulations and guidelines
- Experience with electronic health records
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