CASE MANAGER - RN

Job Summary

The Case Managers are experienced Registered Nurses who interact with the patient, families, physicians and other members of the interdisciplinary team to facilitate quality and cost effective care. An essential component to all roles includes the evaluation of medical necessity and intensity of service of each admission to arrive at decisions regarding medical appropriateness for the requested level of care. Communicates with the various payers/insurance companies to authorize services and ensure appropriate reimbursement to the facility. Actively promotes collaboration among all interdisciplinary care providers, including physicians to effectively identify needs for continued inpatient care or appropriate alternate levels of care. There is coordination to affect an appropriate discharge plan with the Case Managers ensuring arrangements of placement/services upon discharge. Assist to identify and make efforts to correct delays in services, fragmentation of care and gaps in communication. Patient outcome monitoring and participation in continuous performance improvement are also requirements in this role.

About the Role

There is no specific content for this section.

Responsibilities

• Evaluate medical necessity and intensity of service of each admission to arrive at decisions regarding medical appropriateness for the requested level of care.
• Communicate with the various payers/insurance companies to authorize services and ensure appropriate reimbursement to the facility.
• Promote collaboration among all interdisciplinary care providers, including physicians to effectively identify needs for continued inpatient care or appropriate alternate levels of care.
• Afford an appropriate discharge plan with the Case Managers ensuring arrangements of placement/services upon discharge.
• Identify and make efforts to correct delays in services, fragmentation of care and gaps in communication.
• Participate in patient outcome monitoring and continuous performance improvement.

Requirements

• Minimum: Three years recent clinical experience.
• Preferred: Managed care or previous Case Management/Utilization Review experience.
• Excellent communication skills and skills in customer service.
• Demonstrates leadership ability.
• Commitment to the delivery of quality patient care with the ability to develop and maintain effective, professional relationships with all members of the health care team.

Qualifications

• Education: Graduate of a Registered Nurse Program.
• Preferred: Bachelor Degree in Nursing.
• Registration/Certification/Licensure: Current PA RN license.

Skills

• Excellent communication skills.
• Customer service skills.
• Leadership ability.
• Quality patient care commitment.

Benefits

• No specific benefits are mentioned in the job posting.

Pay

• No specific pay information is provided in the job posting.

Schedule

• No specific schedule information is provided in the job posting.

Physical Requirements

• Standing: Frequent
• Walking: Frequent
• Sitting: Frequent
• Stooping: Occasional
• Bending: Occasional
• Twisting: Occasional
• Climbing: Occasional
• Lifting: Constant (up to 20 lbs)
• Pulling: Constant (up to 20 lbs)
• Pushing: Constant (up to 20 lbs)
• Carrying: Constant (up to 20 lbs)
• Reaching Horizontal: Occasional
• Reaching Overhead: Occasional
• Grasping: Constant
• Finger Manipulation: Constant
• Seeing: Constant
• Hearing: Constant
• Repetitive Upper Extremity Use: Constant
• Repetitive Lower Extremity Use: Constant
• Material Handling: Pushing: Constant (up to 20 lbs); Pulling: Constant (up to 20 lbs); Lift: Constant (up to 20 lbs); Carry: Constant (up to 20 lbs)
• Environmental Factors: Working alone: Occasional; Working in cramped quarters: Frequent; Constant Interruptions: Constant
• Cardiovascular Energy Requirements: Physical Demand: Sedentary to Light - CONSTANT; Medium - N/A; Heavy to Very Heavy - N/A