Pay $32.15 - $48.05 / hour
Location: Springfield/Oregon
Employment type: Full-Time
Job Description Req#: CASEM027065
Hourly Base Rate: $32.15 - $48.05
Shift: Day Shift - Remote
Hours Per Week: 40-hours
Date Posted: 6/1/2023
Job Summary:
Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility to comply with government and insurance company reimbursement policies.
Reviews application for patient admission and approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards.
Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay.
Abstracts data from records and maintains compliance with established standards.
Educational/Licensure:
Current Oregon RN state license, or current State RN license and ability to obtain OR RN license within 6 months of hire.
Knowledge in areas such as InterQual Level of Care Criteria and Milliman & Robertson Criteria as well as knowledge of third party payer regulations related to utilization and quality review is also preferred.
Qualifications:
Significant experience in the healthcare field is required including a minimum of five years as a clinical nurse in an acute care setting.
At least five to seven years of experience in case management, discharge planning, and/or utilization review is preferred.
Knowledge of regulatory and payer requirements for Case Management Activities.
Ability to critically evaluate and make decisions about discharge planning for highly difficult cases.
Education Preferred:
Bachelor's Degree
Licenses & Certifications Required:
L-OR-RN License
About the Company McKenzie-Willamette Medical Center is an acute care hospital located in Springfield, Oregon, United States.