Tower Health is a strong, regional, integrated healthcare provider/payer system that offers leading-edge, compassionate healthcare and wellness services to a population of 2.5 million people. Together, our six hospitals and other entities provide a full range of medical care from prevention, screenings & education; to the latest clinical services and surgeries available; to rehabilitation. We also offer wellness programs & public health services that ensure our communities are the healthiest they can be. Our caring, highly trained physicians and staff are committed to patient safety and patient satisfaction.
With more than 11,000 team members, Tower Health includes Reading Hospital, a teaching hospital based in West Reading; Brandywine Hospital in Coatesville; Chestnut Hill Hospital, a teaching hospital in Philadelphia; Jennersville Hospital in West Grove; Phoenixville Hospital in Phoenixville; and Pottstown Hospital in Pottstown. We also operate Reading Hospital Rehabilitation at Wyomissing & Reading Hospital School of Health Sciences, & we have a comprehensive physician network.
Collaboration across Tower Health enables our hospitals, providers, leadership & staff to leverage best practices across the health system. Our hospitals have received national recognition for advanced care in areas such as neurosurgery and stroke, cardiac & vascular surgery, trauma, hematology & oncology. Reading HealthPlex, which opened at Reading Hospital in October 2016, combines state-of-the-art technology and world-class design to make the HealthPlex one of the most sophisticated surgical centers & inpatient facilities in the region.
At Tower Health, we have a rich history of providing high-quality, cost-effective care in the communities we serve. As the healthcare industry continues to change, one thing remains steadfast: Tower Healths commitment to Advancing Health, Transforming Lives
The RN UR Case Manager provides oversight and coordinates day to day functions.
Supervises and monitors the coordination of Utilization Review/Denials Management for designated patient populations. Provides input to the Case Management Director regarding issues and obstacles to timely utilization review. Assists in identifying and creating solutions to barriers that result in delays in transition. Acts as the primary resource to UR staff. Functions as a RN UR Case Manager as necessary. Coordinates the team schedules to ensure adequate coverage. Works closely with IT staff to ensure that the technical needs of the department are being met and assists in coordinating technical activities as needed. Demonstrates the ability to analyze, identify issues and problem-solve effectively. Takes action on issues as appropriate to support successful outcomes. Ensures payer and customer satisfaction by utilizing effective communication and interpersonal skills. Notifies RN Case Manager and physician of all decisions to issue a notice of non-coverage for all payers. Tracks and trends UR data and outcomes as directed. Participates in performance improvement initiatives and performs other UR related functions as directed. Documents according to policy.
Educates members of the healthcare team about managed care principles, observation status, discharge planning, reimbursement rules, and range of patient care settings and acute hospital levels of care.
Demonstrates compliance with all local, state and federal regulations and requirements. Assures adherence to TJC accreditation standards. Completes statistical information according to departmental, state, federal and payer guidelines and regulations. Demonstrates compliance with documentation requirements as reflected through audits
EDUCATION REQUIREMENTS Graduate of an accredited school of Nursing EXPERIENCE Relevant Experience CERTIFICATION AND LICENSURE REQUIREMENTS PA Registered Nurse License REQUIRED SKILLS Excellent Communications Skills Excellent Interpersonal Skills General Clerical Skills
Internal Number: 2019-27604
About Tower Health
Tower Health brings together more than 11,000 dedicated team members, 2,000 nationally recognized physicians, specialists and providers across 65 convenient locations. Our collaborative clinical excellence is leading the healthcare transformation — which means our communities have expanded access to advanced, comprehensive care by renowned physicians, when and where they need it.
Here, we know that advancing the quality of care will transform the quality of life.