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Job Details - Two years case/resource management and utilization management is required.
- Perform clinical reviews by using either InterQual or MCG criteria.
- Provide/send clinical reviews to commercial payers for approval of inpatient acute care stay.
- Management of concurrent denials by providing additional clinical information to support the need for inpatient care.
- Monitor and facilitate the appropriate utilization of internal resources, such as diagnostic testing.
- Coordinate safe discharge planning with members of the interdisciplinary care team and identify barriers to discharge.
- Complete both PRI and Screen for placement of patients in skilled nursing facilities (SNFs).
- Obtain authorizations from commercial payers that is required for placement of patients in SNFs.
Job Requirements - Two years case/resource management and utilization management is required.
- PRI, SCREEN certification preferred.
Additional Details - EPIC electronic medical record experience preferred.
Date Posted: 02 April 2025
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