Clinical Case Manager RN

2 weeks ago


Passaic New Jersey, United States Prime Healthcare Management Inc Full time
Job Summary

Prime Healthcare Management Inc is seeking a highly skilled Clinical Case Manager RN to join our team. As a key member of our healthcare team, you will be responsible for ensuring the quality and resource management of all patients admitted to our facility.

Responsibilities
  • Conduct comprehensive admission and concurrent reviews of medical records to determine medical necessity, intensity of service, and severity of illness.
  • Develop and implement individualized care plans to promote cost containment and achieve quality, clinical, and cost-effective outcomes.
  • Collaborate with healthcare providers to integrate care and achieve seamless delivery of services.
  • Utilize Milliman Criteria and InterQual Criteria to inform clinical decision-making.
  • Provide education and support to patients, families, and healthcare teams to promote optimal health outcomes.
Requirements
  • Minimum 5 years of work experience post-graduation from an accredited school of nursing and a current state Registered Nurse license.
  • Five years of acute care nursing experience preferred, with at least one year of experience in case management, discharge planning, or nursing management.
  • Current BCLS certificate preferred.
  • Knowledge of Milliman Criteria and InterQual Criteria preferred.
  • Basic to intermediate computer skills required.


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