Utilization Management RN PRN

Job Details

Job Summary

Performs utilization management functions, applying medical necessity criteria to determine the appropriate patient status.  Performs denial and appeal activities for inpatient hospital care.  Refers cases to the Physician Advisor per departmental procedures.  Works collaboratively with members of the Case Management Departments and healthcare team to ensure open lines of communication to ensure optimal outcomes and patient care.

Job Description

Job Summary

Performs utilization management functions, applying medical necessity criteria to determine the appropriate patient status.  Performs denial and appeal activities for inpatient hospital care.  Refers cases to the Physician Advisor per departmental procedures.  Works collaboratively with members of the Case Management Departments and healthcare team to ensure open lines of communication to ensure optimal outcomes and patient care.

Minimum Education and Experience Requirements:
Education:
BSN required
AND
Experience:
3 – 5 years case management experience, discharge planning or utilization management experience required.
Minimum Certifications, Registration or License Requirements:
Registered Nurse in state of employment. Certification in InterQual criteria preferred

Salary Range

$35.87 to $51.10 Hourly

The actual hiring rate will be determined based on candidate experience, skills and qualifications. This position is not eligible for an annual incentive.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Kennedy University Hospitals, Inc

Primary Location Address

18 East Laurel Road, Stratford, New Jersey, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.