Nurse Case Manager
2 weeks 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).
About the Role:As a Case Manager, you will work collaboratively with the Utilization Management team, Denial Manager, Physician Advisor, Physician staff, Nursing staff, Case Management, Finance, Clerical Support staff, and payer liaisons to ensure the delivery of efficient and effective healthcare. Your primary responsibilities will include:
- Performing 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.
- Reviewing the admission assessment, collaborating 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.
- Managing observation level of care and working with the attending physician and/or clinical provider caring for the patient to ensure observation status does not exceed 48 hours.
- Identifying system issues that serve as barriers to care and participating in development and implementation of strategies to remove barriers and facilitate performance improvement measures.
- Monitoring efficiencies in scheduling diagnostic procedures and coordination of treatments to facilitate achievement of effective clinical, fiscal, quality, and patient satisfaction goals.
- Reporting information generated from the utilization management referral process for LOS data and physician profile database.
- Collaborating with the unit medical director and/or physician advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
- Notifying physician when patient does not meet criteria for acute care hospitalization, pursuing documentation to justify continued stay within 24 hours.
- Collaborating with the Physician Advisor to facilitate achievement of clinical, quality, financial, and patient satisfaction goals.
- Presenting "Letters of Non-Coverage (LON) to patients and/or families when acute stay is no longer necessary (Third Party and/or Medicare).
- Communicating and securing continued stay authorization with Managed Care Organizations.
- Tracking all carve-outs and submitting reason codes for data entry.
- Serving as a resource to nursing and ancillary staff, providing education on utilization review processes as needed.
- Trending potential barriers to patient advancement through the system, intervening assertively and appropriately when necessary.
- Providing 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.
- Identifying need for patient to be evaluated by other members of the healthcare team and taking appropriate action to facilitate.
To be successful in this role, you will need:
- 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.
As a valued member of our team, you will enjoy a range of benefits, including:
- Medical, dental, vision, life insurance, and tuition assistance.
- 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.
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 range of services, including outpatient services, home health care, urgent care centers, three hospitals, a free-standing emergency department, a Level I trauma center, a Level III neonatal intensive care unit, a comprehensive stroke center, and regional centers of excellence in heart and vascular care, cancer care, and women's health.
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Elk Mills, Maryland, United States ChristianaCare Full timeJob Title: Registered Nurse - Case ManagementChristianaCare is seeking a skilled Registered Nurse to join our team as a Case Manager in our Utilization Management department. This role is part of our Weekend Incentive Program, which offers a unique opportunity to work in a dynamic and fast-paced environment.About the Role:As a Case Manager, you will be...
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