Pediatric Case Manager
5 days ago
Children's Hospital of Philadelphia is committed to delivering exceptional care to its patients. As a Pediatric Case Manager, you will play a vital role in ensuring that our patients receive the highest quality care and support.
About the Role
We are seeking an experienced Registered Nurse with at least five years of experience to join our team as a Pediatric Case Manager. In this role, you will be responsible for providing clinically-based support to the delivery of effective and efficient patient care. You will work closely with our multidisciplinary team to identify opportunities for improving patient outcomes and reducing healthcare costs.
Key Responsibilities
* Determine medical necessity, appropriateness of admission, continuing stay, and level of care using a combination of clinical information, clinical criteria, and third-party information.
* Intervene when determinations are not in alignment with clinical information, clinical criteria, or third-party information to resolve the situation.
* Collaborate with third-party payers to prevent denial of payment and proactively address issues contributing to a potential denial.
* Support the effective prevention and management of denials, including providing requested information as part of the appeal process.
What We Offer
* A competitive salary of $83,000 per year, commensurate with experience.
* Opportunities for professional growth and development through training and education programs.
* A dynamic and supportive work environment that fosters collaboration and innovation.
* Recognition and rewards for outstanding performance and contributions to the organization.
Requirements
* At least five years of experience as a Registered Nurse in a pediatric setting or similar adult setting.
* Previous experience with discharge planning or home care experience is preferred.
* Prior experience as a Case Manager or Utilization Reviewer is also preferred.
* Excellent communication skills, demonstrated organizational skills, and ability to work effectively with all departments and levels of professionals.
Benefits
* Comprehensive health insurance coverage, including medical, dental, and vision benefits.
* Retirement plan with employer match.
* Paid time off, including vacation and sick leave.
* Professional development opportunities and tuition reimbursement program.
Why CHOP?
At Children's Hospital of Philadelphia, we are dedicated to creating a culture that supports the well-being and success of our employees. We offer a comprehensive benefits package, opportunities for professional growth and development, and a dynamic work environment that fosters collaboration and innovation.
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