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RN - Case Manager - Acute Care

Company Name:
Castle Medical Center
POSITION SUMMARY: Assists in collaboration, development, implementation, revision and reporting of the case management program. Is a liaison between the patient, family, nurse, physicians, multidisciplinary team and patient''s healthcare benefactor to optimize outcomes. Serves as a consultant to the healthcare team on specific patient items. Demonstrates Proficiency in the use of InterQual Review Criteria and Milliman Care Guidelines. Performs Utilization Review on assigned patients. Demonstrates a good understanding of managed care trends, Medicare and Medicaid regulations, reimbursement and the effects of utilization on the different methods of reimbursement.
MINIMUM EDUCATION: Graduate of an accredited school of nursing.
MINIMUM FIELD-OF-EXPERTISE: Five (5) years clinical background in area to be managed. Two (2) years experience in utilization management/ review or case management.
REQUIRED CERTIFICATION/REGISTRATION: Licensed Registered Nurse (RN) in the State of Hawaii.
PREFERRED EXPERIENCE: Certified Professional in Utilization Review/InterQual.

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