- Education: Graduate of an accredited school of professional nursing with a current RN licensure in the State of Arkansas.
- Training and Experience: Minimum three years of acute care nursing experience preferred. Experience in Case Management, Utilization Review, Emergency Department nursing, Care Coordination, or Discharge Planning preferred. Experience with InterQual Criteria or Milliman Criteria, Medicare regulations, CMS Conditions of Participation, and third-party payer requirements preferred.
- Job Knowledge: Must demonstrate strong clinical assessment skills. Knowledge of medical necessity criteria. Understanding of CMS regulations and payer requirement. Expertise in discharge planning and care transitions. Effective communication and conflict resolution skills. Ability to prioritize in a fast-paced environment. Knowledge of denial prevention and appeals processes. Ability to work collaboratively with physicians and interdisciplinary teams.
- Safety Sensitive: YES In the interest of protecting the health and safety of all patients, associates, and guests, Unity Health has classified some positions as “safety sensitive.” A “safety sensitive” position is any job position in which impaired performance could result in harm to the health and/or safety of self or others. Any associate that is actively engaged in the use of medical marijuana, even if in possession of a valid medical marijuana card, will be excluded from employment in a “safety sensitive” position.
DESCRIPTION:
The Case Management & Utilization Review RN serves as a clinical leader responsible for coordinating patient care across the continuum, ensuring appropriate utilization of healthcare resources, facilitating timely transitions of care, optimizing reimbursement, reducing avoidable days and readmissions, and supporting high-quality patient outcomes.These roles integrate Emergency Department Case Management, Inpatient Case Management, Utilization Review, UR Analyst, Discharge Planning, Readmission Prevention, Denial Prevention, and Care Coordination. Job roles and definitions will be assigned by the Director. These positions collaborate extensively with physicians, nursing staff, patients, families, payers, post-acute providers, and community resources to ensure patients receive the right care, at the right time, in the right setting.
PHYSICAL REQUIREMENTS:
Job responsibilities include rounding with physicians on nursing units, interacting with patients/families and clinical associates, carry medical records up to 30 pounds, knowledge and use of Meditech, internet applications, Interqual review criteria, and appropriate documentation in the medical record. Interpretation of environmental input requires visual and auditory skills. A significant amount of writing and computer entry is required. The position does have some exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents. Exposure to infectious wastes and body fluids may mandate the wearing of gloves, masks, gowns, and goggles as necessary.
