Registered Nurse Case Manager

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National Coalition of Healthcare Recruiters
Job Overview

(Only QUALIFIED Healthcare Professionals accepted) Case Manager-RN – Registered Nurse Case Manager
Pennsylvania, Philadelphia
JO# 28663

General Summary:
The Manager of Case Management assumes 24-hour responsibility and assists with the direction, management, and evaluation of the Case Management|Social Work departments.
Reports to the Director of Case Management and assists with clinical, operational, and financial aspects of the Case Management|Social Work departments.
Manages all aspects of Case Management and Utilization Management, including admission and continued stay medical necessity reviews, payer authorization, discharge planning, denials management, and ensures adherence to the case management plan.
Assists with hiring, training, directing, development and evaluating of staff.
Assists with development of action plans, and may report outcomes to the Case Management Director, CNO, or others as applicable.
Assists with the design, implementation, training, and resources for the Case Management system for the organization.
Evaluates personnel, assesses environment, and determines priorities for care in order to plan, implement, and evaluate outcomes of care.
Evaluates the effectiveness of existing clinical protocols and pathways and makes recommendations for new ones.
Works effectively with MCO staff and leadership to decrease denials or downgrades in reimbursement.
Ensures collaboration among health care providers across the Continuum of Care to maximize effective access and efficient utilization of resources.

Experience:
3+ years Case Management experience required
2+ years nursing supervisory|management experience in acute care required
Managed Care Organization (MCO) experience preferred

Education:
Bachelor of Science in Nursing (BSN) required
Masters Degree in Nursing or related preferred

Certifications|Licensures:
Registered Nurse License required
Certified Case Manager (CCM) highly desired
Healthcare Quality of Utilization Review (HQUR) a plus

Ideal Candidate:

RN Registered Nurse Responsibilities:

As a RN Case Manager, your ability to manage client care with specific knowledge and experience in bedside care, symptom management, crisis intervention and family intervention are feature assets for this high-profile nursing position. In addition to excellent written|verbal communication, problem solving and decision making abilities, our candidate has a demonstrated experience developing and maintaining rapport with patients and families, and the ability to work well with an interdisciplinary team.

RN Registered Nurse Rewards:

Receive unparalleled training
Competitive pay
Industry-leading benefits including comprehensive health coverage, generous time off, 401K, and more
Education benefits such as student loan repayment assistance, education discounts, and in-house continuing education training
Unlimited growth opportunities in a variety of roles or locations

Special Skills:
Must be able to use independent decision-making skills in a wide variety of situations
Frequent contact with employees, physicians, customers, community individuals and volunteers
Must be self-motivated to complete work in a timely manner to meet deadlines
Experience with Core Measures, Quality Indicators, Case Management, and Utilization
Knowledge base of InterQual criteria
Knowledge of Managed care trends, Medicare, and Medicaid regulations
Advanced negotiation and mediation skills

Job Detail
  • Job IDnchcr-2321235
  • StreetN/A
  • StatePennsylvania
  • Postal CodeN/A
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