Case Manager

at  RWJBarnabas Health

Req #: 0000176342
Category: Social Work
Status: Per Diem
Shift: Day
Facility: Newark Beth Israel Medical Center
Department: Case Management

QUALIFICATIONS:

Required:

• Graduate of an accredited Registered Professional nursing program. Licensed to practice professional nursing in New Jersey.
• Bachelor s degree in Nursing preferred.
• At least two years of relevant clinical experience required. 3-5 years experience in acute care nursing preferred.
• Experience working with insurance companies preferred.

Preferred:

SCHEDULING REQUIREMENTS (NON-EXEMPT POSITIONS):

• Per Diem
• Day

• Timely admission review.Continued stay review performed concurrently. Applies knowledge of growth and development over the life span.Discharge review as necessary.Retrospective review as indicated.Application of Milliman Care Guidelines and Interqual criteria (severity of illness and intensity of service).Quality issues.Level of care changes (skilled, intermediate, custodial).Termination of benefits.Collaborates with physician advisor on level of care changes, denials, and communication issues with other physicians.Identification of inappropriate resource utilization.When issuing a letter to the patient/family concerning level of care changes, denial of days, etc., explains to the patient/family the UM process and federal regulations as they pertain to the individual case.Interfaces with third-party payers for the purpose of providing pertinent clinical data and for initiating and maintaining clear channels of communication to maximize reimbursement.
• Screens patients in the pre-admission and admission phase in a timely manner.Identifies patient, family and system issues through assessment on a continual basis and addresses issues as necessary (e.g., communicates with Utilization Management, Social Work).Applies knowledge of growth and development over the life span.Applies the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned caseload, i.e., Infant, Adult, Pediatric, Geriatric and Adolescent.Assess data reflective of each patient s status and interprets information needed in order to identify each patient s age requirements relative to his or her age specific health care needs.