Utilization Care Manager

Summary:

Reports to the Director of Care Management or designee. Conducts surveillance over medical necessity of patient care records. In collaboration with the physician of record and the Utilization Review Committee physician ensures the appropriate level of patient care is provided and that admission and concurrent authorizations from third party payers are obtained. Ensures appropriate and timely utilization of resources and services so that patients receive high quality safe and fiscally responsible care.

Responsibilities:

Demonstrates a fundamental grounding in nursing theory and practice with a clinical background within a defined content area. Remains current on the latest concepts techniques and methods relative to his/her service.Demonstrates knowledge of federal and state rules and regulations. Applies InterQuallevel of care screening criteria to all admissions within one business day of admission. Interacts with team and physicia...