RN Case Manager PRN
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POST DATE 9/13/2016
END DATE 11/5/2016
Salt Lake City, UT
JOB DESCRIPTIONJob Code: 00954-32903
St. Mark's Hospital provides a full array of services to the surrounding community, including the following service lines: cardiac, NICU, orthopedics, behavioral health, skilled nursing, acute rehab, as well as many others. St. Mark's is the oldest running hospital in Utah with rich traditions and a reputation for excellent patient care and quality outcomes. St. Mark's Hospital is nestled at the foot of the Wasatch Mountains and only a stone s throw away from many national parks, including Moab, Zion, Canyonlands, etc.
The PRN Case Manager performs activities focused on assessing medical necessity on all patient accounts, regardless of payer source. He/She will perform clinical reviews on both inpatient and outpatient accounts using approved InterQual criteria to evaluate medical necessity, admission status, level of care assignments, and continued stay review. He/She is responsible for identifying and obtaining additional authorizations, facilitating authorizations for referrals, communicating with and accurately documenting all communications with third party payers in accordance with facility policies and procedures. He/She will initiate/escalate denial management activities concurrently, and serve as a liaison with the Patient Account Services (PAS) and others to minimize financial risk to the patient and facility.
* Current licensure as a RN in the State of Utah.
* BSN preferred.
* Five years nursing experience in acute care setting, Utilization Review experience preferred. Demonstrates an ability to organize, perform and track multiple tasks accurately in short timeframes of one continuously scheduled shift or less. Ability to establish and maintain collaborative and effective working relationships with internal and external customer.
Last Edited: 09/10/2016