Case Manager
1 day ago
Christiana Care is seeking a skilled Case Manager to join our team in Newark, DE. As a Case Manager, you will play a critical role in ensuring the delivery of efficient and effective healthcare services to our patients.
About the Role:This is a full-time position working 3 out of 4 weekends per month, with a 12-hour shift on Saturdays and Sundays from 7pm-7am. As part of our Weekend Incentive Program, you will receive a special rate of pay and full benefits, except for Paid Time Off (PTO).
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 and 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.
- Track all carve-outs and submit reason codes for data entry.
- Serve as a resource to nursing and ancillary staff, providing education on utilization review processes as needed.
- Provide 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.
- Identify need for patient to be evaluated by other members of the healthcare team and take appropriate action to facilitate.
- 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.
Christiana Care is one of the country's most dynamic healthcare organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering healthcare costs. We offer a comprehensive benefits package, including medical, dental, vision, life insurance, tuition assistance, and more.
We are an equal opportunity employer and welcome applications from diverse candidates. If you are a motivated and experienced Case Manager looking for a new challenge, please submit your application today.
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