Case Manager, BSN - Care Coordination, Full-Time, Vineland/Elmer

Inspira Health•Vineland, NJ

11h•$48 - $64

About The Position

The Case Manager facilitates a patient’s hospitalization from pre-admission through discharge. The role collaborates with physicians, nurses, social workers, and other members of the healthcare continuum to ensure appropriate, cost-effective care. Using clinical expertise and medical necessity criteria, the Case Manager performs utilization management, care coordination, resource utilization, and discharge planning. The Case Manager uses established criteria to review the appropriateness of admission and continued stay. Through initial and ongoing assessment, the role develops timely transitional care plans that support each patient’s needs and help prevent hospital readmission. The Case Manager identifies potential transition-of-care barriers; ensures discharge plans align with the patient’s clinical course, continuing care needs, and covered services; identifies patients or families who need social work referrals; participates in multidisciplinary rounds; and collaborates with next-level-of-care providers as appropriate.

Requirements

At least 3 years of experience in a hospital setting.
Licensed Registered Nurse in New Jersey.
BSN required for hires after September 1, 2021. For Mannington, employees hired on or after June 1, 2023 must have a BSN or enroll in a BSN program within 6 months of employment and obtain a BSN by their third work anniversary in a position requiring a BSN.
For employees hired before the BSN requirement, an associate degree is required.
Excellent oral and written communication and interpersonal skills to communicate with families, patients, interdisciplinary healthcare team members, vendors, and third-party payors.
Excellent clinical and administrative skills and judgment.
Proficiency in Microsoft Office.
Ability to work independently and set priorities to coordinate care plans efficiently.

Nice To Haves

1–3 years of case management experience.
Clinical background in the assigned unit or service line.
Previous utilization management experience.
Previous experience with regulatory and compliance requirements.
CCM, ACM, CMC, RNBC, CPUR, or NCBC certification.
Working knowledge of Milliman criteria.

Responsibilities

Facilitate patients’ hospitalizations from pre-admission through discharge.
Collaborate with physicians, nurses, social workers, and other healthcare-continuum members to ensure appropriate, cost-effective care.
Perform utilization management, care coordination, resource utilization, and discharge planning using clinical expertise and medical necessity criteria.
Use established criteria to review admission appropriateness and continued stay.
Conduct initial and ongoing assessments and develop timely transitional care plans that support patient needs and help prevent readmissions.
Identify and prevent potential barriers to transitions of care.
Ensure discharge plans are consistent with patients’ clinical courses, continuing care needs, and covered services.
Identify patients and families who require social work referrals.
Participate in multidisciplinary rounds.
Collaborate with next-level-of-care providers as appropriate.