Registered Nurse Case Manager Inpatient Specialist

3 weeks ago

Philadelphia, Pennsylvania, United States The Children's Hospital of Philadelphia Full time
Job Title: Registered Nurse Case Manager Inpatient

Job Summary:

We are seeking a highly skilled Registered Nurse Case Manager to join our team at The Children's Hospital of Philadelphia. As a key member of our healthcare team, you will be responsible for providing clinically-based support to the delivery of effective and efficient patient care. Your expertise will be instrumental in ensuring the best possible outcomes for our patients and their families.

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.
  • Validate admission and continuing stay criteria with third-party payers and attending physicians.
  • 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.
  • Assess patients and families for continuing care needs to develop, implement, and evaluate an effective discharge plan in collaboration with the multidisciplinary team.
  • Communicate and coordinate with patients/families related to reimbursement issues and to create a discharge plan.
  • Use clinical knowledge and knowledge of anticipated response to treatment to assess patient progression towards anticipated outcomes.
  • Address actual/potential barriers to discharge.

Requirements:

  • At least five (5) years of experience as a Registered Nurse.
  • Previous experience with discharge planning or home care experience is preferred.
  • Prior experience as a Case Manager or Utilization Reviewer is preferred.
  • Previous experience in a pediatric setting or similar adult setting is preferred.

Skills and Abilities:

  • Excellent communication skills and demonstrated organizational skills.
  • Ability to work effectively with all departments and all levels of CHOP professionals.
  • Ability to work independently or within a team structure.
  • Must be very organized and able to work independently.
  • Ability to establish priorities among multiple needs, meet deadlines, and maintain standards of productivity.
  • Knowledge of managed care admission process (i.e., verification of benefits, admissions notification).
  • Ability to effectively negotiate with internal and external providers of patient care services.
  • Sound problem-solving skills.
  • Excellent customer service orientation and strong interpersonal skills.
  • Computer skills and a working knowledge of Word, Excel, and Access.

Licenses and Certifications:

  • Registered Nurse (Pennsylvania) - Pennsylvania State Licensing Board - upon hire - Required.
  • Accredited Case Manager (ACM) - American Case Management Association (ACMA) - upon hire - Preferred.
  • Certified Case Manager (CCM) - Commission for Case Manager Certification - upon hire - Preferred.

CHOP's Commitment to Diversity, Equity, and Inclusion:

CHOP is committed to building an inclusive culture where employees feel a sense of belonging, connection, and community within their workplace. We are a team dedicated to fostering an environment that allows for all to be their authentic selves. We are focused on attracting, cultivating, and retaining diverse talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children.

Why CHOP?

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care-and your career.

How to Apply:

Apply now to join our team of dedicated healthcare professionals and make a difference in the lives of our patients and families.

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