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RN - Utilization Management

Description:

RESPONSIBLE FOR:
The purpose of this position is to ensure that acute hospital admission have the appropriate level of care, patient status, plan of care and meet medical necessity for an acute hospitalization. This role monitors that the patient is progressing in their plan of care and meet medical necessity for continued stay. This role ensures that the patient's payer has the clinical information with which to authorize an acute hospital stay and the continued stay services to include covered days and associated services.

MINIMUM EDUCATION REQUIRED:
Degree from an accredited nursing school required, Bachelor of Science in Nursing preferred

MINIMUM EXPERIENCE REQUIRED:
Two (2) years of experience in an acute, post-acute or payer setting

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
Current unrestricted registered nurse (RN) license, in the state of Georgia

ADDITIONAL QUALIFICATIONS:
Master's degree preferred and three years utilization review or Care Management experience