Review requests for authorization and monitor care during authorized periods of stay for levels of care. Reviews patients' medical charts to ascertain the medical necessity for services and the appropriateness of level of care.
Conduct on-site review of medical records at clinical facilities according to organization standards.
Maintain frequent telephone contact with clinical service providers to perform defined duties and facilitate communication between the organization and the provider.
Document UR/case management activities such as precertifications, concurrent and retrospective reviews.
Consult regularly with other organization staff to review treatment plans when level of clinical care requires further clarification.
Maintain a tracking system and clear, concise records for monitoring and reviewing cases.
Prepare documentation/case synopsis upon closure of cases as required by clients.
Provide phone crisis intervention services and precertification evaluations for inpatient hospitalization and other levels of care.
Provide consultation and training to providers regarding authorization procedures and utilization review for a specific course or nature of treatment.
Contribute to policy review and procedure development and evaluation.
Performs other duties as assigned, some of which may be essential to the job.
Â·The information above is for summary purposes, and is not intended to be a comprehensive list of essential functions.
Graduate of an accredited school of nursing
BSN required within 5 years of employment
Current RN license in the state of CO
Minimum of three years clinical nursing experience in an acute care setting
Knowledge and experience with managed care
Three years case management experience in an acute care setting using evidence-based criteria for screening medical necessity
SCL Health is a faith-based, nonprofit healthcare organization that operates eight hospitals, four safety net clinics, one children’s mental health center and more than 190 ambulatory service centers in three states – Colorado, Kansas and Montana. The health system includes 15,000 full-time associates and more than 500 employed providers.