Clinical Utilization Manager

4 weeks ago


Newark, Delaware, United States ChristianaCare Full time
Job Summary

ChristianaCare is seeking a skilled RN Case Manager to join our team in Newark, DE. As a Utilization Management Specialist, you will play a critical role in ensuring the delivery of efficient and effective healthcare services.

Key Responsibilities
  • Conduct admission and concurrent reviews to identify medical necessity, level of care, and appropriateness of setting using established criteria and clinical guidelines.
  • Collaborate with primary nurses 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 attending physicians and/or clinical providers to ensure observation status does not exceed 48 hours.
  • Identify system issues that serve as barriers to care and participate in the 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 the achievement of effective clinical, fiscal, quality, and patient satisfaction goals.
Requirements
  • 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.
Physical Demands

Ability to ambulate within the hospital setting (walking, stairs, etc.). Occasional sitting, standing, and lifting loads of 5-10 pounds. Ability to utilize computer equipment/programs. Ability to sit or stand at a computer workstation and proficiently utilize computer equipment/programs for long periods of time.

Working Conditions

Occasional exposure to office materials (i.e., White Out, Toner, etc.).



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