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Utilizing InterQual and other appropriate criteria, responsible for reviewing all admissions and continued stay of patients in conformance with the established criteria set forth in the hospital's utilization management and quality assurance plan. Will determine the medical necessity for admission and continued stays for patients within department's scope of service and to meet the hospital's objectives for assuring a high quality of patient care as well as assuring the effective and efficient utilization of available health services. Identifies appropriate level of care for inpatients and outpatients requiring overnight care.
Education
Other Graduate of an accredited school of nursing Required
Bachelor's Degree BSN Required
Experience
1 year experience of recent Utilization Review in acute care or in insurance company setting. Required
1 year experience in medical-surgical setting. Required
1 year experience in working with competency utilizing InterQual criteria. Required
General Experience in working with utilization review standards Required
Licenses
PA Registered Nurse License Required
Certified Case Manager Preferred
Multi State Compact RN License Required Or
Schedule: Monday–Friday, 8:00 AM–4:30 PM with every 3rd weekend required
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