This position functions autonomously and in collaboration with all members of the healthcare team to coordinate and facilitate quality, cost-effective care while minimizing fragmentation of the healthcare delivery system for ESRD and CKD patients.
The Telephonic Utilization Management Nurse Reviewer will conduct clinical review to determine medical necessity of Post-Acute Care services utilizing appropriate guideline/criteria for precertification of requested services.
In this role, you will be responsible for performing admission and continued stay review for appropriate patient status/written order documentation, communication with medical staff, supplying complete clinical information for third party payor review, formulates and implements a discharge plan and ensures complete documentation is available to support the medical necessity of the admission as well as discharge disposition.
In this role, the selected candidate will coordinate care by serving as the contact point, advocate and resource for the patient, their family and their physician, building effective relationships through trust, respect and communication.
The Utilization Management (UM) Case Manager provides leadership, direction, and coaching to the healthcare team with a primary focus on matching patient care needs to the appropriate admission or continued stay status through the use of evidence-based tools, physician engagement and clinical expertise.
In this role, you will collaborate with the health care team to coordinate patient and family interventions across the continuum of care, removing barriers and promoting efficient and effective use of resources.
In this role, the selected candidate will collaborate with other members of the Corporate Case Management team to develop policies and procedures to support systems, standards of practice, regulatory standards, and evidence-based best practices in support of discharge planning.