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Veterans Affairs, Veterans Health Administration
Clarksburg, West Virginia
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Carilion Clinic
Roanoke, Virginia
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Utilization Review Coordinator / Case Management / PRN
DescriptionPOSITION 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.Requirements
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