RN Case Manager I - Special Needs & Ambulatory Dept

RN Case Manager I - Special Needs & Ambulatory Dept

Philadelphia PA

Full-time

Industry: Healthcare / Health Services
Job Category: Medical / Health - Nurse

Responsibilities:

The Case Manager coordinates, manages and procures the discharge needs of patients identified as requiring post acute care services via initial admission screen, assessment and consults. This is achieved by collaboration with the family, the care team including physicians, nursing and other healthcare professionals. The Case Manager performs daily utilization review and conveys pertinent telephonic information to third party payers to secure appropriate acute care reimbursement within the time requirements of the payer. The Case Manager appeals 100% of all third party payer denials for acute care reimbursement according to the guidelines for the PA Region. The Case Manager performs ongoing PI/QA during concurrent review to identify quality of care issues, risk management issues, and performs blood/blood products and medication utilization.


Qualifications:

Education Requirements

4 year/bachelor's degree

Experience

Relevant Experience

Certification and Licensure

PA Registered Nurse License

Required Skills

Computer Skills to include use and navigation.
Excellent Communications Skills
Excellent Interpersonal Skills
Microsoft Word