Veracity Software Pvt. Ltd. · 3 months ago
Utilization Review / Case Manager (RN)
Chicago, IL
Full-time
Onsite
Entry, Mid Level
2+ years expVeracity Software Pvt. Ltd. is seeking a Utilization Review/Case Manager (RN) to facilitate appropriate use of hospital resources and ensure timely discharge planning. The role involves collaboration with various healthcare professionals and managing patient care efficiently.
Information Technology & Services
Responsibilities
Perform inpatient utilization management per plan, payer requirements, and standards
Collaborate with physicians and healthcare team members for timely and appropriate patient management
Collect and document clinical data to support admission and continued hospitalization
Provide accurate clinical information to payers as required
Support DRG Assurance Program with accurate data collection and assignment
Perform non-acute profiling, collect data on avoidable days, and refer cases to Physician Advisor when needed
Participate in family meetings and care conferences
Ensure timely referrals for discharge planning and use of regional/community resources
Refer complex cases to Social Services as appropriate
Ensure psychological needs of patients are met via direct intervention or referral
Act as a central communicator with patients, families, vendors, payers, and hospital staff
Provide continuity of care by leveraging community resources and maintaining updated resource manuals
Refer cases not meeting criteria to Physician Advisor in a timely manner
Follow up with Medical Director/Physician Advisor on unresolved issues
Maintain safe patient care environment and infection control compliance
Manage departmental operations (phones, supplies, data tracking)
Attend in-service presentations and complete all mandatory education
Perform other duties as assigned
Qualification
Required
Graduate of an accredited school of nursing (Required)
Current RN License in Illinois (Required)
Strong written/oral communication skills with appropriate grammar and vocabulary
Proficiency in Microsoft Word and Excel (Required)
Ability to provide excellent customer service at all times
Ability to anticipate and coordinate multiple functions effectively
Preferred
2+ years relevant clinical experience (Preferred)
Utilization management experience (Preferred)
Knowledge of Medicare/Medicaid, Managed Care, and Commercial insurance processes (Preferred)
Company
Veracity Software Pvt. Ltd.
At Veracity, if you have an idea you want to validate, a product you need to build, or an existing product that needs optimization, our teams are trained to jump in wherever needed.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase