Case Manager

Independence Health System Careers•Butler, PA

1d•Onsite

About The Position

The Case Managers are experienced Registered Nurses who interact with the patient, families, physicians and other members of the interdisciplinary team to facilitate quality and cost effective care. An essential component to all roles includes the evaluation of medical necessity and intensity of service of each admission to arrive at decisions regarding medical appropriateness for the requested level of care. Communicates with the various payers/insurance companies to authorize services and ensure appropriate reimbursement to the facility. Actively promotes collaboration among all interdisciplinary care providers, including physicians to effectively identify needs for continued inpatient care or appropriate alternate levels of care. There is coordination to affect an appropriate discharge plan with the Case Managers ensuring arrangements of placement/services upon discharge. Assist to identify and make efforts to correct delays in services, fragmentation of care and gaps in communication. Patient outcome monitoring and participation in continuous performance improvement are also requirements in this role.

Requirements

Graduate of a Registered Nurse Program
Current PA RN license
Three years recent clinical experience
Excellent communication skills
Skills in customer service
Demonstrates leadership ability
Commitment to the delivery of quality patient care
Ability to develop and maintain effective, professional relationships with all members of the health care team.

Nice To Haves

Bachelor Degree in Nursing
Healthcare Provider CPR
Managed care or previous Case Management/Utilization Review experience.

Responsibilities

Evaluate medical necessity and intensity of service of each admission to arrive at decisions regarding medical appropriateness for the requested level of care.
Communicate with various payers/insurance companies to authorize services and ensure appropriate reimbursement to the facility.
Promote collaboration among all interdisciplinary care providers, including physicians to effectively identify needs for continued inpatient care or appropriate alternate levels of care.
Coordinate to affect an appropriate discharge plan, ensuring arrangements of placement/services upon discharge.
Identify and make efforts to correct delays in services, fragmentation of care and gaps in communication.
Monitor patient outcomes and participate in continuous performance improvement.