Bilingual Clinical Case Manager

Job Summary: The Utilization Review Specialist performs telephonic review of clinical services. This review will determine the medical necessity as well as alternative levels of care, utilizing clinical expertise, judgement and established criteria.

Job Qualifications: Bachelors Degree Or Equivalent


3 Or More Years Of Related Experience

1. Must be a registered nurse with a minimum of 3 year clinical experience in medical, surgical, orthopedic, 
neuro-surgery or psychiatric nursing.

2. Demonstrated knowledge of medical criteria.

3. Computer literacy.

4. CPUR preferred.

5. Call Center experience is an asset

6. Bilingualism (French/English)is mandatory for all Canadian employees.

Job Accountabilities:

 1. Reviews and monitors the medical treatment plans of injured parties.

2. Applies clinical expertise, nursing judgment and established medical criteria to determine medical necessity of care proposed.

3. Review information in medical record; obtain and review information from patient, physician and other participants in the care of patient; determine whether care of patient is an exception to established criteria for the diagnoses and problems that apply to that patient.

4. Review process and outcome of medical care by comparing actual care of individual patient with criteria of care established of the appropriate medical service.

5. May report on any adverse event or product complaint discovered through patient interaction.

6. Elevate to Medical Director cases not meeting criteria in a timely manner according to Best Practices.



Please apply today!


Keywords: Case Manager, Care Manager, Case Management, Care Management Discharge Planner, Utilization Reviewers, Certified Case Manager, Certified Care Manager, Utilization, Utilization Review, Discharge, RN, RN Case Manager, RN Care Management, Registered Nurse, Staff RN, Nurse, Staff Nurse, Acute Care, Hospital, CMSA, Case Management Society of America, ACMA, American Case Management Association

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http://www.torontojobsandcareers.ca/jobapply.php?ad=1326492676