Christiana Care Health System, a Magnet(r) health care organization with over 1,100 beds between its two hospitals (Christiana Hospital & Wilmington Hospital) and the only Level I trauma service on the East Coast corridor between Philadelphia & Baltimore, has been honored repeatedly as "One of America's Best Hospitals" by U.S. News & World Report. Christiana Care Health System is always seeking like-minded professionals to join us in our commitment to providing the best patient care in the region. Just named 3rd in the Top 10 Best Hospitals to work for in the North East.
The Christiana Care Health System is currently recruiting a Full Time Registered Nurse to join the Care Management Team at the Christiana Hospital. This is a full-time, office base day shift, Case Management/Utilization Management position. No weekends. No holidays.
We are seeking an energetic, motivated RN that wants professional autonomy and understand the importance of care coordination. The Case Manager/Utilization Manager is a vital member of the interdisciplinary team that is responsible to create, implement, and monitor treatment plans to ensure safe, timely, and effective transitions throughout the care continuum and discharge planning.
Monday-Friday 8a-4:30p, No Weekends, No Holidays
Generous Paid Time Off, Competitive Pay & Robust Benefits Package.
Highly engaged and motivated team
24/7 Leadership Support
To provide longitudinal care management for an identified population of patients/members in conjunction with the patient's primary physician provider, according to agree-upon clinical guidelines, with the objective of coordinating high quality patient care across all care delivery sites.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Concurrent review of observation and inpatient medical records throughout the patient's hospitalization.
Analyzes clinical status of patient (Observation v. Inpatient), current treatment, past medical history and identifies potential gaps in physician documentation.
Communicates with physicians or other providers to validate admission status and appropriately prompts for documentation if necessary, either verbally or written.
Ongoing review of precertification requests for medical necessity
Enters Avoidable Delays timely
Engaging in payer Denial Management
Ensure Letters of NonCoverage are provided appropriately and timely
Ensures Medicare compliance via utilization management
EDUCATION AND EXPERIENCE REQUIREMENTS:
Graduate of an accredited school of nursing; BSN within 3 years of hire
Active Clinical RN License required; Master's degree preferred;
Minimum of 1 -2 years of clinical experience in acute care.
Case Management or utilization management experience desirable.
Case Management Certification required within 18 months of hire.
KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:
Knowledge of nursing principles and practices and process.
Knowledge of case management principles practices and process.
Knowledge of disease management principles practices and process.
Skill in oral and written communication.
Exceptional telephone skills; Ability to communicate via telephone with patients, physicians and staff in a professional manner.
Ability to use computer systems for data input and retrieval.
Ability to collaborate with clinicians and administrative staff.
Ability to exercise tact, judgement and diplomacy.
Internal Number: JR51519
About Christiana Care Health System
Christiana Care Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are... positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.