Case Manager - Utilization Review On-Site

Overview

At Monroe Hospital, our dedicated team of professionals is committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system in the United States, Monroe Hospital is actively seeking new members to join its award-winning team!

Monroe Hospital is a 32-bed community hospital located in beautiful Bloomington, Indiana. Monroe Hospital is committed to providing superior healthcare, ever mindful of each patient's individuality and unique needs.

Monroe Hospital has been recognized by Healthgrades as a Patient Safety Excellence Award recipient, a distinction that places Monroe Hospital among the top 10% of all short-term acute care hospitals. For more information, please visit www.monroehospital.com.

We are an Equal Opportunity Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

Education and Work Experience

Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.

Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.

Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred. Current BCLS (AHA) certificate upon hire and maintain current.

Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic to intermediate computer skills. Behavioral Violence Prevention Training within 3 months of hires and maintain current.

#LI-AS2