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.
In this role, you will collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individuals benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.
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, the selected candidate will complete routine and emergency assessments on each patient as indicated by departmental policy; coordinate clinical and psycho-social and spiritual services as indicated by Plan of Care through case management.
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 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.