Case Manager, BSN- Care Coordination, Full-Time, Vineland/Elmer
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 healthcare continuum members 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 functions. The Case Manager reviews admission and continued-stay appropriateness using established criteria, conducts initial and ongoing assessments, and develops timely transitional care plans that support patient needs and help prevent readmission. The role identifies and addresses potential barriers to transition, ensures discharge plans align with the patient’s clinical course, continuing care needs, and covered services, identifies patients or families needing social work referral, participates in multidisciplinary rounds, and collaborates with next-level care providers as appropriate.
Requirements
- Minimum 3 years of experience in a hospital setting.
- Licensed Registered Nurse in New Jersey.
- BSN required for hires after September 1, 2021. For Mannington only, 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 the BSN by their third work anniversary in a BSN-required position.
- For employees hired before the BSN requirement, an associate degree is required.
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.
- Excellent oral and written communication and interpersonal skills for communicating 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.
- Working knowledge of Milliman criteria.
Responsibilities
- Facilitate a patient’s hospitalization from pre-admission through discharge.
- Collaborate with physicians, nurses, social workers, and other members of the healthcare continuum 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 the appropriateness of admission and continued stay.
- Conduct initial and ongoing assessments and develop timely transitional care plans that support patient needs and help prevent hospital readmission.
- Identify and prevent potential barriers in transitions of care.
- Ensure discharge plans are consistent with the patient’s clinical course, continuing care needs, and covered services.
- Identify patients and/or families who require social work referral.
- Actively participate in multidisciplinary rounds.
- Collaborate with next-level-of-care providers as appropriate.
Benefits
- Benefits information is provided through the employer’s benefits offerings link.
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What This Job Offers
Job Type
Full-time
