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St. John's Episcopal Hospital has exciting new opportunities for RN Care Managers ( Utilization Review) Full Time , Union Position. Tuition Reimbursement.
The RN Care Manager reports to the Director of Care Management/Utilization Review. It is the responsibility fo the Care Manager to review patient encounters across the continuum of care, utilizing appropriate criteria sets.
Responsibilities include but are not limited to:
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Performs a case management intake assessment, which includes patient physical, psychosocial and financial needs issues. Interviews the patient or designated agent regarding situation and needs at the time of admission.
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Conducts a concurrent medical record review using specific indicators and the InterQual Criteria as approved by the hospital. Provides clinical reviews to third party payors within agreed timeframes as indicated.
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Collaborate with SW and interdisciplinary team to expedite discharges for patients that are not appropriate for inpatient care.
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Discusses case with the attending physician, physician advisor and resident, regarding the appropriateness of resource utilization, consultations and treatment plan.
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Performs a discharge review then discuss with the physician those cases no longer meeting inpatient criteria. Places patient on alternate level of care status when appropriate.
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