POSITION SUMMARY: Registered Nurse uses approved screening criteria (MCG®/CMS Inpatient List) to determine the medical necessity of a requested hospitalization and the appropriate level of care for that patient. Actively involved in the continued management of patient status/LOC. Provides consultative role as utilization management nurse to clinical and non-clinical departments. Documents objective findings against approved indicators. Assists with retrospective reviews and medical necessity denials per communication with third party payors. Follows UR policies and procedures and assists with continually improving the quality and effectiveness of the utilization management program at CSVRMC.
Apply Now Not ready to apply? Join our Talent PoolUnspecified
70058270
Utilization Review Coordinator / Case Management / PRN
CHRISTUS St. Vincent Health System
Social Services
1-10%
455 st michaels drive
Santa Fe, NM 87505
View On A Map
View Other Locations
PRN