Froedtert Health

RN UTILIZATION REVIEW, FCH - ENTERPRISE QUALITY CDI/UR/DM

Posted on

February 14, 2025

Job Type

Full-Time

Role Type

Utilization Review

License

RN

State License

Compact / Multi-State

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Company Description

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.

Job Description

Requirements

EXPERIENCE DESCRIPTION: Minimum of 3 years of acute care nursing experience is required; Prior utilization management or case management experience is required. A minimum of 5 years of acute care nursing experience is preferred. Utilization of Interqual, MCG care web QI or Indicia evidence based guidelines is strongly preferred. EDUCATION DESCRIPTION: Professional knowledge of nursing theory and practice at a level normally acquired through completion of a program at an accredited School of Nursing is required. Bachelor's Degree in Nursing is preferred. SPECIAL SKILLS DESCRIPTION: Knowledge of Medicare inpatient only surgical list, Medicare guidelines for admission, working DRG, and some familiarity with hospital coding is preferred. LICENSURE DESCRIPTION: Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). MCG certification is required within 18 months of hire. Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred.

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Responsibilities

Assumes responsibility for assessing a patient's clinical status on admission and daily to determine the appropriate admission status type and level of care. Refers cases to the physician advisor, PA moonlighter, for a second level review as needed. Facilitates communication with service based multidisciplinary team as it relates to the patient and identified treatment plan. Works in accordance to established policies and procedures to ensure optimal patient outcomes. Has the ability to work with variable service lines and with multiple care teams.

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