Nurse Case Manager
1 week ago
ChristianaCare is seeking a skilled Registered Nurse (RN) to join our team as a Case Manager in Utilization Management. This role is part of our Weekend Incentive Program (WIP), which offers a special rate of pay and full benefits, except for Paid Time Off (PTO), for working 3 out of 4 weekends per a four-week schedule.
About the Role:- Collaborate with the Utilization Management team, Denial Manager, Physician Advisor, Physician staff, Nursing staff, Case Management, Finance, Clerical Support staff, and payer liaisons to ensure efficient and effective healthcare delivery.
- 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.
- 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.
ChristianaCare 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.
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