Pennsylvania Licensed Case Manager

Job Summary

A company is looking for a Case Manager - Utilization Management.

Key Responsibilities

• Review patient admissions to evaluate appropriateness and ensure compliance with third-party payer requirements
• Provide clinical reviews and develop methods to improve departmental efficiency
• Collaborate with care managers and other departments to facilitate accurate patient class assignments and maximize reimbursement

Required Qualifications

• Specialized Diploma in nursing
• 2 years of previous utilization review experience
• 2 years of knowledge of utilization management related to third-party payers
• RN - Licensed Registered Nurse in Pennsylvania upon hire
• Ability to maintain HIPAA compliance and work in a team environment