Job Description
Position Summary:
Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the InterQual Criteria guidelines. Monitors the utilization of resources of all patients reviewed. Maintains confidential communication with physicians and multi-disciplinary personnel to meet individual needs or the patients served. Functions as an independent contributor as well as a team member.
Position Qualification:
- Communication is an essential skill requiring the ability to see, hear, and speak.
- Fluent in written and spoken English.
- Must be able to fulfill the essential functions of the position.
- Possess three or more years of acute care hospital experience preferred.
- Familiar with the operations of the healthcare industry and healthcare delivery systems.
- Able to use the medical record in order to obtain clinical information to perform InterQual reviews.
- Utilize Outlook, and the computer-based systems (AllScripts) to perform reviews.
- Work experience in Medical-Surgical, Telemetry, Critical Care, and/or Pediatrics, NICU preferred.
Required Licenses/Certifications:
- Current Florida RN Licensure.
- Must possess a solid clinical background to accomplish extensive Medical Record review.
- Computer skills preferred
We do not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.
Must clear background and drug test required.