Utilization Case Manager, RN

Responsibilities

• Implements and supports the philosophy, mission, values, standards, policies and procedures of The Ohio State University Wexner Medical Center.
• Contributes to the hospitals Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services based on documented clinical information in compliance with CMS guidelines and other payer requirements regarding appropriate level of care.
• Maintains an awareness of State and National health care trends, JCAHO, CMS and third party payor Utilization Management guidelines.

Qualifications

• Bachelor’s degree, Masters preferred.
• RN licensure required.
• Three years of Case Management and/or Utilization Management experience required.