Care Manager (RN) **Hospital Care Management Experience Highly Preferred** (Sunday-Thursday, 8:00AM-4:00PM)

Coordinate post-acute care transitions by performing initial utilization reviews using InterQual and Milliman Care Guidelines to determine appropriateness of patient settings. Screen inpatients for discharge needs, develop collaborative discharge plans incorporating patient preferences, and implement referrals to appropriate post-acute services. Provide clinical reviews to payers to secure certification of patient days, mediate concurrent denials with the Attending Physician and Physician Advisor, and maximize provider reimbursement through accurate insurance reviews. Complete documentation in Allscripts, track avoidable days, and issue required notices including ABNs and Code 44 in accordance with CMS conditions and payer contracts. Participate in interdisciplinary meetings to assess clinical status and resolve discharge plan barriers.