Rn - Case Manager - Utilization Review - Full Time - Days
Mohawk Valley Health System
Utica, NY, US
Base: $40.19 - $56.51 hourly; bonus/equity: not sp...
On-site
Utilization review and management
Clinical decision making
Payer authorization processing
The RN Utilization Management role gathers clinical information to determine appropriateness of admission, continued stay, and patient status throughout a hospital stay
Job Summary
The RN Utilization Management role gathers clinical information to determine appropriateness of admission, continued stay, and patient status throughout a hospital stay.
This position collaborates with care managers, providers, discharge planners, and other care team members to ensure appropriate patient care and documentation.
The role requires completing timely admission and continued stay reviews, coordinating peer-to-peer calls with payers, and maintaining utilization review databases.
Matching Summary
The RN Utilization Management role gathers clinical information to determine appropriateness of admission, continued stay, and patient status throughout a hospital stay.
Salary
Base: $40.19 - $56.51 hourly; Bonus/Equity: Not specified; Benefits: Not specified
Skills & Requirements
Must-have
Utilization review and management
Clinical decision making
Payer authorization processing
Collaboration with care teams
Epic EMR proficiency
Medical necessity criteria knowledge
Nice-to-have
Excellent communication skills
Interpersonal skills
MS Office Excel proficiency
Key Requirements
Graduate of accredited nursing program
3-5 years clinical RN experience
1 year hospital case management experience
NYS Registered Nurse license
Knowledge of Care Guidelines and Medical Necessity Criteria