Omega-Himagine Solutions

Case Management Utilization Review RN

Posted on

March 20, 2025

Job Type

Full-Time

Role Type

Case Management

License

RN

State License

Oregon

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Company Description

Job Description

The Utilization Review RN monitors utilization practices from preadmission to discharge to assure cost-effective utilization of resources, quality patient care, and compliance with regulatory requirements.

Requirements

RN: Registered Nurse Licensed by Oregon State Board of Nursing Preferred: Bachelor's degree in Nursing CCM: Certified Case Manager ACM: Accredited Case Manager Phy-Sit comfortable position, frequent opportunity to move Enviro-Indoor-Comfortable area Hazards-Only unplanned exposure to blood, body fluids HIPAA-Pay-View or read only minimum for work assignment HIPAA-Treat-Originate, view, change nec for work assignment HIPAA-Ops-View or read only minimum for work assignment

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Responsibilities

This role is responsible for reviewing the medical record to ensure documentation demonstrates medical necessity according to regulatory guidelines. The Utilization Review RN will actively manage and communicate with key members of the care team to secure accurate documentation and admission status

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