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Utilization Management Nurse - ED - 1p -11:30p
PRIMARY FUNCTION: Responsible for ensuring the delivery of efficient and effective health care while evaluating the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provision of the applicable health benefits plan. PRINCIPAL DUTIES AND RESPONSIBILITIES: UTILIZATION MANAGEMENT - Performs admission and concurrent review to identify medical necessity, level of care and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission - Reviews the admission assessment, collaborates with primary nurse and other health care providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes. - Manages observat


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