MAJOR FUNCTION: 

Facilitates a patient’s hospitalization from pre-admission through discharge. Collaborates with physicians, nurses, social workers and other members of the healthcare continuum to ensure appropriate, cost-effective care. Applies clinical expertise and medical necessity criteria to perform the functions of utilization management, care coordination, resource utilization, and discharge planning. Must utilize established criteria to review appropriateness of admission and continued stay. Perform initial and ongoing assessment to ensure a timely transitional care plan is developed that will support each patient’s needs and prevent hospital readmission. Identify and prevent potential barriers in transition of care. Ensure discharge plan is consistent with 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.

QUALIFICATIONS:

Education & Experience:

BSN required if hired after September 1, 2021.  For Mannington only, all hired on or after June 1, 2023 have BSN required, or must enrolling a BSN program by 6 months of employment and obtain their BSN by their 3rd work anniversary in a BSN required position. Hired prior to BSN preferred, associate degree required.       Minimum 3 years of experience in hospital setting required. 1-3 years of case management experience preferred. Clinical background in assigned unit/service line preferred. Previous utilization management experience preferred. Previous experience with regulatory and compliance requirements preferred.  

Certification/Licensure:    

Licensed Registered Nurse in New Jersey required. Case Management Certification preferred.

Knowledge & Skills:

Demonstrates excellent communication skills (oral and written) and interpersonal skills necessary to communicate with families, patients, interdisciplinary healthcare team members, vendors, and third-party payors for optimum care. Excellent clinical and administrative skills and judgement.   Proficiency in Microsoft Office. Ability to work independently, setting priorities to coordinate care plans efficiently. Working knowledge of Milliman criteria preferred.           Physical Requirements: 
N: Never       O: Occasionally (<20%)       F: Frequently (20%-80%)       C: Constantly (>80%) Lifting <20lbs F Standing F Sitting C Lifting 20-50lbs O Climbing O Kneeling O Lifting>50lbs N Crouching O Reaching F Carrying O Hearing C Walking F Pushing O Talking C Vision C   Environmental Conditions: Noise F Varied Temperatures O Cleaning Agents O Noxious odors N Patient Exposure F Operative Equipment N