Case Manager
4 weeks ago
We are seeking a skilled Case Manager to join our team at Christiana Care Hospital. As a Case Manager, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.
About the Role:The Case Manager will work closely with the Utilization Management team, Denial Manager, Physician Advisor, Physician staff, Nursing staff, Case Management, Finance, Clerical Support staff, and payer liaisons to ensure seamless coordination of care.
Key Responsibilities:- Perform admission and concurrent review to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines within 24 hours of admission.
- Review the admission assessment, collaborate with primary nurse and other healthcare providers to ensure a multidisciplinary plan-of-care is in place to meet identified patient care needs and desired outcomes.
- Manage observation level of care and work with the attending physician and/or clinical provider caring for the patient to ensure observation status does not exceed 48 hours.
- Identify system issues that serve as barriers to care. Participate in development and implementation of strategies to remove barriers and facilitate performance improvement measures.
- Monitor efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate achievement of effective clinical, fiscal, quality, and patient satisfaction goals.
- Report information generated from the utilization management referral process for LOS data and physician profile database.
- Collaborate with the unit medical director and/or physician advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
- Notify physician when patient does not meet criteria for acute care hospitalization, pursue documentation to justify continued stay within 24 hours.
- Collaborate with the Physician Advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
- Presents "Letters of Non-Coverage (LON) to patients and/or families when acute stay is no longer necessary (Third Party and/or Medicare).
- Communicate and secure continued stay authorization with Managed Care Organizations.
- Tracks all carve-outs and submits reason codes for data entry.
- Serves as a resource to nursing and ancillary staff, providing education on utilization review processes as needed.
- Trends potential barriers to patient advancement through the system, intervenes assertively and appropriately when necessary.
- Provides On-call support for the Transfer Center to evaluate medical necessity and appropriateness when a request is obtained from an outside facility for patient transfer to Christiana Care.
- Identifies need for patient to be evaluated by other members of the healthcare team and takes appropriate action to facilitate.
- Active DE RN licensure or compact state RN licensure.
- Bachelor's degree in nursing.
- Minimum of 3 years recent experience as a Registered Nurse in acute care, adult care setting.
- Clinical Documentation, Performance Improvement, Case Management, or Utilization Management experience desirable.
- Completes a minimum of 8 continuing education credits (CEU'S) per year in Utilization and/or Case Management.
- Actively participates in department operational planning work groups.
- Medical, Dental, Vision, Life Insurance, Tuition assistance, etc.
- Two retirement planning offerings, including 403(b) with company contributions.
- Generous paid time off with annual rollover and opportunities to cash out.
- 12-week paid parental leave.
- Incredible Work/Life benefits including annual membership to access to backup care services for dependents through retirement planning services, financial coaching, fitness and wellness reimbursement, and great discounts through several vendors for hotels, rental cars, theme parks, shows, sporting events, movie tickets, and much more.
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