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Travel Nurse RN - Case Manager - 1, Per Week
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$7,972 a month
- Essential Management- Utilization Review and Care Transitions & CoordinationProviding clinical information to payers, monitoring length of stay, seeking necessary care authorizations and utilizing the InterQual Program; appealing denials as indicated within a timely fashion.
- Assesses, intervenes, evaluates and determines level of care to establish accurate admission and/or observation status; demonstrates basic knowledge of DRG reimbursement, evidenced by standardized measures for length of stay and acuity level status designation.
- Works collaboratively with multidisciplinary team to determine each patient's needs concurrently including post-acute care when needed; addresses LOS issues, appropriate leveling of patient status; addressespotential needs, resources, referrals for other disciplines etc.
- Denials/Appeal Process: Completes assessment of denial within 1 week providing supporting documentation with outcome of review; documents intervention in the UR EMR section.
- Submits denials/appeals when completed to the department secretary for processing.
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