RN Case Manager PRN - Utilization Review (Remote) Job at Inova Health System
As a Registered Nurse (RN) Case Manager – Pro re nata (PRN), you will actively participate in clinical performance improvement activities and provide discharge planning and continuity of care for assigned patients in the acute and post-acute setting. To help achieve our mission, you will understand pre/post-acute resources while providing coordination of services and acting as a key Liaison between patients, families and interdisciplinary healthcare members. Your utilization of management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities is of vital importance. Taking ownership for the timely regulatory compliance and facilitation of precertification and payer authorization processes, when indicated, is essential. Working with the multidisciplinary team on implementing and evaluating patient care plans and progression throughout the continuum of care is required. Collaborating with physicians, nurses and other members of the multidisciplinary care team to effect timely and appropriate patient management is expected.
Requirements
- Education: BSN
- Experience: 1 year of case management or clinical experience
- License: Active RN license in VA
- Certification: BLS through the American Heart Association
Job Responsibilities
- Provides coordination of services and acts as a key Liaison between patients, families and the interdisciplinary healthcare team members.
- Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities.
- Discusses payer criteria and issues on a case by case basis with clinical staff and follows-up to resolve problems with payers as needed.
- Identifies at risk populations by using approved screening tools and following established reporting procedures.
- Participates in the assessment of patients' clinical and psychosocial needs through review of patient information, personal contact with patients/families and interdisciplinary healthcare team members.
Our commitment to keeping patient’s safe means there’s no safer place for you to work. We safeguard our patients, by safeguarding our team members.
Inova is well stocked with the best and latest PPE
- Masks are provided to patients entering our buildings, and offered free to visitors
- Covid-19 patients are isolated in dedicated areas
- Inova operates curbside Covid-19 testing sites that are far removed from the main facilities
- All team members are trained in the latest screening guidelines
Inova is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
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