Pool Case Manager Utilization Review
The Utilization Review Case Manager validates the patient's placement to be at the most appropriate level of care based on nationally accepted admission criteria. Team member uses medical necessity screening tools, to complete initial and continued stay reviews in determining appropriate level of patient care, appropriateness of tests/procedures and an estimation of the patient's expected length of stay. The Utilization Review Case Manager secures authorization for the patient's clinical services through timely collaboration and communication with payers as required. The Utilization Review Case Manager follows the process as defined in the Utilization Review Plan in accordance with the TGH Conditions of Participation for Utilization Review. Essential Functions 1. Admissions Reviews 2. Concurrent Reviews 3. Case Escalations for appropriate status 4. Concurrent Denials Management 5. Interdisciplinary discussions and Provider partnerships
Qualifications
Education Associate's Degree- Nursing License/Registration Registered Nurse- Issued by Florida or Compact State Work Experience and Additional Information Three (3) years as a practicing RN in an acute care setting and least two (2) years' experience as a case manager HMO/Managed Care/Medicare/Medicaid experience
Primary Location
Crystal River
Work Locations
TGH Crystal River 6201 N Suncoast Boulevard Crystal River 34428 Eligible for Remote Work : On Site
Job
Case Management
Organization
Tampa General Hospital-Citrus
Shift
Day Job
Job Type
On Site Shift Hours : 8-4:30PM
Minimum Salary
47.00
Pool Case Manager Utilization Review in crystal river at Unknown Company
This position is listed as full time and onsite.