Registered Nurse - Utilization Management - Full Time (varied hours) - Jefferson

Job Details

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

• interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Collaborates with the Physician Advisor and members of the Multidisciplinary Team to facilitate the Case Management Condition 44 process.
• Applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards.
• Performs appeal process in coordination with specific third party payor format, protocols, and timelines.

Work Shift

Workday Evening (United States of America)

Worker Sub Type

Regular

Employee Entity

Jefferson Health Northeast

Primary Location Address

10800 Knights Road, Philadelphia, Pennsylvania, 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.