RN Case Manager

Hudson Regional Hospital • Secaucus, NJ

10d • $58 - $62

About The Position

Provides case management and routine discharge planning services to patients and their families. The role facilitates safe and timely discharges, enhances the benefits of medical care, supports hospital reimbursement, promotes cost-effective acute care, and ensures continuity of care.

Requirements

• Current RN license in the state of New Jersey.
• At least 1–2 years of direct patient care experience in an acute care hospital.
• Knowledge of Medicaid, Medicare, managed care review and documentation requirements, and applicable state and federal regulations and DNV standards and practices for acute care facilities.
• Excellent written and verbal communication skills.
• Knowledge of discharge planning, length-of-stay initiatives, home care, and referral processes.
• Expert critical-thinking and problem-solving skills.

Nice To Haves

• Knowledge of utilization review criteria, including InterQual and/or Milliman.
• Previous case management experience.

Responsibilities

• Review patient charts within 24 to 48 hours of admission to assess admission appropriateness, intensity of service, and potential discharge needs in accordance with utilization and contractual requirements.
• Communicate questionable cases, including inappropriate admissions, level-of-care changes, and quality issues, to the Attending Physician; refer unresolved cases to the Physician Advisor.
• Communicate with insurance providers for admission and continued-stay reviews as stipulated by contract to certify patient stays.
• Contact the Attending Physician to obtain additional clinical information to minimize denials and assist with reimbursement of care and appeals.
• Refer denied-day cases to the Physician Advisor.
• Participate in Interdisciplinary D/C Rounds to collaboratively review and facilitate patients’ plans of care, and act as a liaison to identify opportunities to improve care.
• Keep the Director of Case Management informed of problem areas and seek guidance in a timely manner.
• Coordinate care with ancillary departments and the attending physician, including rehabilitation, laboratory, and radiology, to ensure timely care, reduce length of stay, and support appropriate treatment and discharge.
• Perform other assigned job duties and responsibilities.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed