Case Manager RN

About the role

The Case Manager’s primary duties are to provide Utilization Review and Case Management functions for the organization under the direction of the Director, Case Management and within the established policies and procedures. He/she performs preadmission, concurrent and retrospective review for all payers; completes assessments for the purpose of identifying discharge-planning needs; and provides discharge-planning services for select patient populations.

Responsibilities

• Performs continuous assessments and evaluations to ensure patient is progressing towards desired outcomes
• Affords patient/family needs by coordinating efforts of other team members
• Identifies and resolves barriers that hinder effective patient care
• Collaborates and consults with physicians on patient’s progress and discharge planning needs
• Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity
• Manages the process to review and, as appropriate, appeal denials received from payers
• Counsels with patients and family members in decision making and in meeting psycho social needs of the patient
• Maintains knowledge of resources and facilities available to patients and family members
• Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions
• Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities
• Applies knowledge of the patient population served; proves age-specific care; applies knowledge of expected norms in planning care
• Promotes internal and external customer satisfaction
• Builds and promotes a culture of service excellence and continuous improvement

Qualifications

• Required: Registered Nurse Licensure
• Preferred: Bachelors or Masters of Science in Nursing; knowledge of CMS guidelines and experience working with payer specific guidelines and contractual rules; previous UR or hospital Case Management experience
• One to three years of experience in a hospital or health care system
• Assertive and persuasive communication skills, action oriented

Benefits

Portsmouth Regional Hospital offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing

Pay

Commensurate with experience

Schedule

Nightly Shifts