CASE MANAGER

Premier Health • Dayton, OH

10d

About The Position

The Case Manager is a registered nurse responsible for individualized patient assessment, care coordination, and transition planning to promote optimal patient outcomes, appropriate length of stay, effective resource use, and adherence to established guidelines of care. The role facilitates interdisciplinary team collaboration and serves as a liaison among patients, physicians, payors, families, and significant others regarding care coordination and transitional care needs.

The position promotes care coordination and effective resource utilization by assessing patient care needs during hospitalization and across the healthcare continuum. It requires expertise in acute care nursing, healthcare reimbursement requirements, clinical outcome data analysis, utilization management, transition planning and processes, resource allocation, team management, and communication. Success is measured by achievement of targeted goals and outcomes developed through care team collaboration.

Requirements

• Bachelor of Science in Nursing (BSN).
• Registered Nurse with a valid Ohio license.
• Minimum of three years of relevant clinical experience in the area of the patient population within the last five years.
• Required negotiation, conflict resolution, and assertive communication skills.
• Ability to develop and maintain rapport with physicians and Integrated Care Team members.
• Experience gathering information, monitoring indicators, and using feedback mechanisms.
• Basic computer skills.

Nice To Haves

• Certification in an area of clinical specialty.
• Expertise in healthcare reimbursement, transition planning, and case management.
• Experience with a clinical documentation management program.
• Knowledge of the performance improvement process.
• Knowledge of InterQual ISD-A and Milliman Guidelines.
• Knowledge of third-party insurance requirements.

Responsibilities

• Assess patients individually and identify their care needs during hospitalization and across the healthcare continuum.
• Coordinate patient care and plan transitions to promote optimal outcomes, appropriate length of stay, and effective resource utilization.
• Facilitate collaboration among interdisciplinary care team members.
• Liaise with patients, physicians, payors, families, and significant others regarding care coordination and transitional care needs.
• Promote adherence to established guidelines of care and achievement of targeted goals and outcomes.
• Gather information, monitor indicators, and use feedback mechanisms.

What This Job Offers

• Job Type: Full-time