Collaborates with the interdisciplinary healthcare team to ensure the delivery of high quality evidence-based care. Uses current utilization review practices, Milliman criteria and appropriate clinical judgment to support the team and coordinate care for discharge planning, transitions of care, provision of ancillary services and follow up communication. Minimum knowledge, skills, and abilities: v Registered Nurse, graduate of an accredited nursing program. RN Licensure in the State of Iowa. v BSN required. v Experience in Case Management preferred. v 3 years minimum previous hospital/ acute care experience. v Knowledge of insurance, utilization review, Medicare, Medicaid v Knowledge of JCAHO requirements, CMS Core Measures. v Ability to read and communicate effectively in English. v Strong written and verbal skills. v Basic computer skills, Microsoft office, Outlook. v Must demonstrate critical thinking skills and decision-making ability. v Ability to communicate with tact and professionalism. v Ability to work independently. v BLS required.
