Registered Nurse (RN) Case Manager – Utilization Review

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Registered Nurse (RN) Case Manager – Utilization Review

Registered Nurse (RN) – Case Manager/Utilization Review

 

Shift or schedule: Monday – Friday; either 7:30am -4:00pm or 9:00am-5:30pm (depending on location assigned.); No on call or weekends.

 

Job Summary: 

The Case Manager staff work either the Medical/Surgical Unit (ACU/CCU) or Surgical Services/ED. Med/Surg Unit is 25 beds. ED has 14 rooms. Duties include but are not limited to: Discharge planning. Completion of Milliman for inpatient/observation medical necessity. Utilization review-discussions with insurance companies, providers and provider office staff. Obtaining medical information from providers prior to elective procedures to ensure medical necessity is met for the scheduled status (inpatient, extended recovery, etc.) Arranging DME such as hospital beds, home oxygen, other equipment and supplies. Scheduling home health.

 

Requirements: 

  • Must have prior experience in the discharge planning/utilization review role
  • Must have a Minimum of at least 2 years experience.
  • Prefer prior experience with Milliman or Interqual computer programs.
  • RN, licensed to work in Wyoming.
  • BLS certification.

 

 

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