Overview
Job Summary
Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.
Responsibilities
Utilization Review
Discharge planning
Readmission Reduction Participation
Payer Communication and denial reduction
Completes assigned goals.
Specifications
Experience
Minimum Required
RN with at least one (1) year of clinical experience
Preferred/Desired
RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Education
Minimum Required
Diploma or Associate Degree in Nursing
Preferred/Desired
BSN or MSN
Training
Minimum Required
Preferred/Desired
Certified Case Manager
Special Skills
.
Minimum Required
Critical thinking skills, communication, organization, interpersonal and computer skills. Problem solving; and governmental regulations.
Preferred/Desired
Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Licensure
RN
Minimum Required
RN
Preferred/Desired
RN;CCM;ACM