Case Manager / Utilization Review Nursing

Case Management nurses (also called Utilization Nurses) are usually nurses that have previously worked as a floor nurse. From the moment the patient enters the healthcare facility, the case manager is planning their discharge. These nurses have thorough knowledge of billing, Medicare, Medicaid, and community services. It is the case manager's job to ensure that the patient's care follows the proper guidelines for reimbursement from insurance and that the patient receives efficient and complete care according to the standardized plan of care for the patient's specific illness. Case managers review patient's charts for daily updates from the interdisciplinary team and coordinate team care. Case managers also ensure that consulted physicians assess the patients in a timely manner. Nurses in this capacity may also arrange for medical device and services companies to visit the patient in the hospital and/or the home should the patient need home-going oxygen or assistive devices such as a walker.

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