• Demonstrates knowledge and skills necessary to provide services based on the physical, psychosocial, educational, safety, and other related criteria for appropriate population in his/her assigned area.
• Maintains required core competencies.
• Complies with set Policies and Procedures (i. e. name tag, dress code, parking, smoking, etc.)
• Submits appeals in a timely manner, upon request by the Director.
• Monitors for the efficient use of resources and reports to leadership when there are actual or potential sources of under- or over-utilization.
• Collaborates with providers, nurses, patients, families, and other care providers in the development and implementation of patient care plans, including discharge planning, across the continuum of care in support of the GCRMC Mission.
• Communicates with providers regarding patient status and assists him/her in ensuring proper utilization of resources.
• Conducts utilization review using nationally recognized medical necessity criteria and documents the review.

• Utilization management, assurance of comprehensive clinical documentation, utilization procedures, appropriate clinical documentation for utilization review and communication with third party payors.

• Refers cases for second level reviews when medical necessity criteria are not met.

Education

Required:

Associate of Science

Preferred:

Bachelor of Science

Licenses & Certifications

Required:

L-RN Singlestate

Preferred:

L-RN Multistate