Case Manager - University Care (Wilkens Avenue)

University of Maryland Faculty Physicians • Baltimore, MD

4d

About The Position

Under general supervision, provides utilization management, care coordination and discharge planning for an assigned patient case load. This role is patient focused, outcome-oriented, and based on general and specialty professional standards, and functions within a multi-disciplinary practice model; and other duties as assigned. EDUCATION and/or EXPERIENCE Licensed as a Registered Nurse (RN) in the state of Maryland. Graduation from an accredited school is required Master’s degree or certification as Case Manager preferred Minimum of 5 years clinical nursing experience. Experience in acute care, as well as home health, ambulatory care and/or occupational health is preferred Knowledge of managed care, discharge planning, utilization and case management is required Experience in case management and knowledge of payer mechanisms and clinical utilization management is highly preferred

Requirements

• Licensed as a Registered Nurse (RN) in the state of Maryland.
• Graduation from an accredited school is required
• Minimum of 5 years clinical nursing experience.
• Knowledge of managed care, discharge planning, utilization and case management is required

Nice To Haves

• Master’s degree or certification as Case Manager preferred
• Experience in acute care, as well as home health, ambulatory care and/or occupational health is preferred
• Experience in case management and knowledge of payer mechanisms and clinical utilization management is highly preferred

Responsibilities

• Coordinates the integration of social services/case management functions into the patient care, discharge, and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities.
• Conducts concurrent medical record review using specific indicators and criteria as approved by medical staff, JCAHO, CMS, and other state agencies.
• Acts as patient advocate: investigates and reports adverse occurrences, and performs staff education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
• Promotes effective and efficient utilization of clinical resources.
• Mobilizes resources and interviews, as needed, to achieve expected goal to assist in achieving desired clinical outcomes within the desired timeframe.
• Ensures that patient tests are appropriate and necessary and are carried out within the established timeframe and that results are promptly available.
• Conducts review for appropriate utilization of services from admission through discharge. Evaluate patient satisfaction and quality of care provided.
• Initiates and presents “denial letters”, as appropriate.
• Assesses patient care required throughout continuum of care for diagnosis, procedures and DRG’s.
• Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship.

Benefits

• University of Maryland Faculty Physician’s Inc. offers a total rewards package that supports our employees' health, life, career and retirement. More information can be found here: https://www.umfpi.org/jobs/summary-employee-benefits

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees