Cameron Memorial Community Hospital - Angola, IN
posted 24 days ago
Full-time - Mid Level
Angola, IN
11-50 employees
Hospitals
About the position
The Nurse Utilization Review/Case Manager at Cameron Memorial Community Hospital is responsible for coordinating quality, cost-effective care for patients across the healthcare continuum. This role involves collaboration with various stakeholders, including patients, providers, and community agencies, to assess needs, create treatment plans, and ensure compliance with regulatory guidelines. The position primarily operates during the day shift with some weekend responsibilities.
Responsibilities
- Collaborate with patients, providers, nurses, social workers, caregivers, payers, and community agencies to assess and plan care.
- Create individualized and comprehensive case management and treatment plans.
- Conduct admission reviews for Medicare, Medicaid, and private insurance patients based on CMS guidelines.
- Anticipate and review denials by payors and intervene with written appeals to avoid revenue loss.
- Identify and record preventable delays or avoidable days in care progression.
- Facilitate the best discharge plan for patients in collaboration with the healthcare team.
Requirements
- Licensed Registered Nurse in the State of Indiana.
- Bachelor's degree in nursing or higher, or an Associate degree with enrollment in an accredited bachelor's program with completion within 12 months.
- Three years of hospital clinical experience.
Nice-to-haves
- Knowledge of available community resources and external agencies.
- Expertise in InterQual Level of Care Criteria and local/national coverage determinations.
- Proficient professional writing skills for appeal writing.
Benefits
- Health insurance
- Paid holidays
- Flexible scheduling
- Professional development opportunities
