This role requires decisive judgment, strong relationship-building skills, and the ability to lead and educate healthcare teams. The incumbent will provide resources and guidance on care progression, utilization of services, appropriate care levels, and safe patient transitions.
Key responsibilities include conducting thorough clinical assessments, applying critical thinking, making informed decisions, and organizing care effectively. Collaboration with internal and external stakeholders is essential, along with effective written and verbal communication skills. Knowledge of federal and state utilization review and appeal processes is preferred.
Qualifications include a minimum of three years’ RN experience, preferably in acute care or emergency settings, with expertise in medical necessity criteria and discharge planning. A Bachelor of Science in Nursing is preferred, and certification in Case Management (CCM) is a plus.
This position emphasizes delivering patient- and family-centered care within a collaborative healthcare environment focused on quality and compassion.