Quality Healthcare

Close To Home

Best Performer

High-Quality Patient Experience

Family Health Centers

Primary Care for Everyone

RN Case Manager/Utilization Review

Website Community Memorial Hospital

Quality Healthcare Close To Home

The RN Case Manager will facilitate patient care by assessing patient needs, evaluating treatment options, create treatment plans, and coordinates care options and services needed. This involves the assessment of patient and family needs and the development, implementation and evaluation of an appropriate Plan of Care, making updates in response to changing patient needs.

Case Management

  • Develops or implements an interdisciplinary Plan of Care based on the needs identified during the assessment, with input from the patient, in collaboration with the attending physician and other team members.
  • Manages and coordinates patient care which ensures the efficient and appropriate services and community support systems
  • Communicates all changes in the patient’s status and ensures action is taken in a timely manner.
  • Documents all patient care and coordinating services required.

Utilization Review

Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment.

  • Balance quality of care with cost efficiency
  • Compile and review medical information and insurance coverage
  • Authorize requested medical services
  • Prepare cases for physician review
  • Inform patients about their benefits and coverage limits
  • Identify alternative, cost-effective resources

Requirements:

  •  Two years of comprehensive nursing assessments, documentation experience required
  •  RN licensure
  •  Strong written and verbal skills
  •   Proficient computer skills
  •  Excellent clinical evaluation abilities