Case Manager- Care Coordination, Full-Time, Mullica Hill

Inspira Health Network • South Harrison Township, NJ

90d

About The Position

The Case Manager for Care Coordination facilitates a patient's hospitalization from pre-admission through discharge. This role involves collaboration with physicians, nurses, social workers, and other members of the healthcare continuum to ensure appropriate, cost-effective care. The Case Manager applies clinical expertise and medical necessity criteria to perform functions of utilization management, care coordination, resource utilization, and discharge planning. Responsibilities include utilizing established criteria to review the appropriateness of admission and continued stay, performing initial and ongoing assessments to develop timely transitional care plans, identifying and preventing potential barriers in the transition of care, and ensuring discharge plans are consistent with the patient's clinical course and continuing care needs. The Case Manager also identifies patients and/or families who require social work referral and actively participates in multidisciplinary rounds, collaborating with next level of care providers as appropriate.

Requirements

• BSN required if hired after September 1, 2021.
• For Mannington, BSN required for hires after June 1, 2023, or must enroll in a BSN program within 6 months.
• Associate degree required for those hired prior to BSN requirement.
• Minimum 3 years of experience in a hospital setting required.
• 1-3 years of case management experience preferred.
• Clinical background in assigned unit/service line preferred.
• Previous utilization management experience preferred.
• Previous experience with regulatory compliance requirements preferred.
• Licensed Registered Nurse in New Jersey required.
• Case Management Certification preferred.

Nice To Haves

• Excellent communication skills (oral and written).
• Excellent clinical and administrative skills and judgment.
• Proficiency in Microsoft Office.
• Ability to work independently and set priorities.
• Working knowledge of Milliman criteria preferred.

Responsibilities

• Facilitate a patient's hospitalization from pre-admission through discharge.
• Collaborate with healthcare team members to ensure appropriate care.
• Apply clinical expertise and medical necessity criteria for utilization management.
• Perform initial and ongoing assessments for transitional care planning.
• Identify and prevent potential barriers in transition of care.
• Ensure discharge plans align with clinical course and continuing care needs.
• Identify patients/families needing social work referral.
• Participate in multidisciplinary rounds.
• Collaborate with next level of care providers.

What This Job Offers

• Job Type: Full-time
• Industry: Educational Services
• Education Level: Bachelor's degree