Utilization Management Nurse - Patient Case Management

Overview Responsible for performing a comprehensive review of the medical record to assess for accuracy in the assignment of patient class (status) that is congruent with the patient's clinical condition, physician intent, medical necessity and current rules and regulatory requirements. Documents accurate and timely clinical reviews to support medical necessity and obtain payer authorization. Complies with current rules and regulatory requirements pertaining to utilization management. Communicates and collaborates with providers and members of the health care team to promote optimal, appropriate, and cost- effective utilization of resources. Identifies, addresses, and mitigates avoidable days whenever possible. Department Description Serving the community since 1961, WakeMed Health & Hospitals is the leading provider of health services in Wake County. With a mission to improve the health and well-being of our community, we are committed to providing outstanding and compassionate care. For more information, visit www.wakemed.org. EOE Licensure Registered Nurse Required- And Certified Case Manager Or Commission for Case Management Certification Required- Within 24 Months of Hire Education Graduate Nursing Required- And Bachelor's Degree Required- And Bachelor's Degree Nursing Preferred Experience 3 Years Nursing- Related Area Required- And 5 Years Nursing- Related Area Preferred- And Direct Position Experience In Clinical- Case Management Or Clinical- Discharge Planning Or Accounting/Finance- Third Party Review Or Clinical- Utilization Management Preferred