Position Summary: Performs utilization review, resource management, and discharge planning utilizing Interqual criteria and making referrals for second level physician review to determine appropriateness of admission category. Identify opportunities for improvement in patient care and resource management and participate in Performance Improvement Activities. Collaborates with insurance companies by performing clinical reviews and discharge planning. Coordinates a multidisciplinary plan of care with patients, families, and healthcare providers. Ensures compliance with regulatory requirements related to discharge planning. Documents review activities in Case Management electronic records and discharge planning in the electronic patient record.
Other Qualifications: Proficient PC skills, knowledge of Interqual criteria and data collection. Florida RN required.