Job description
RN Case Manager - Utilization Review - Orthopedic MedSurg Observation Unit
The Case Manager/Utilization Review Nurse manages transition planning for patients and evaluates the medical necessity, appropriateness, and efficiency of healthcare services. This position involves reviewing patient medical records and care plans to ensure that treatments are in line with established guidelines and insurance coverage. The primary goal is to balance quality patient care with cost-effectiveness, ultimately ensuring that healthcare resources are used efficiently. This position also functions as a key liaison between healthcare providers, facilities, and insurance companies, and collaborates with clinical teams to ensure care plans are justified and appropriate.
Hours: 7am - 4pm, M - F