Job Details

Position : RN Case Manager

The Case manager Utilization Review Nurse promotes cost effective allocation of the GFCH resources while maintaining the highest quality of care; coordinates the patient’s care, treatment and services based on the patient’s needs. 

The UR/Case Manager RN works with the multidisciplinary team to ensure that all patients are safely transitioned to the most appropriate level of care once the physician has determined acute care is no longer necessary.

In collaboration with the patient’s primary nurse, the UR/Case Manager RN will assist in providing thorough patient education, and discharge instructions as appropriate.

The UR/Case Manager is responsible for overseeing utilization of services, reviewing medical necessity of admission, appropriateness of setting, extended stays and professional services.

The UR/Case Manager addresses medical necessity denials with attending physician and UR committee; reports statistical information including but not limited to the number of admissions, payor source, length of stay, condition 44s, condition code W2 and number of re-admissions. 

The UR/Case Manager reviews all policies and procedures related to Case Management, Discharge Planning, and Utilization Review to ensure compliance with accrediting standards and state regulations. 

The UR/Case Manager completes and documents the Discharge Plan Evaluation, as well as the coordination, assessment and re-assessment of the plan. The evaluation plan must include the likelihood of the patient needed post-hospital services and the availability of those services.

With the support of Administration and Clinical Leadership, the UR/Case Manager RN will comply with Joint Commission standards for Case Management/Discharge Planning and Utilization Review.