CASE MANAGER

Premier Health Partners; Dayton (OH); On-site; USD 65,000 - 85,000; Full time

Job summary

Premier Health Partners is seeking a Case Manager (RN) at Miami Valley Hospital in Dayton, OH. The role focuses on individualized patient assessment, care coordination, and transition planning to promote optimal outcomes and appropriate length of stay.

Responsibilities include interdisciplinary team collaboration and liaison with patients, physicians, payors, and families. Requires a BSN and Ohio RN license, with at least three years of relevant clinical experience.

Qualifications

• BSN required.
• Registered Nurse with valid Ohio license.
• Certification in area of clinical specialty preferred.
• Minimum of three years of relevant clinical experience in area of patient population within last five years.
• Experience with a clinical documentation management program preferred, knowledge of performance improvement process preferred.
• Exemplary interpersonal skills and effective communication with physicians and Integrated Care Team members.

Responsibilities

• Individualized patient assessment and care coordination.
• Transition planning to promote optimal outcomes and appropriate length of stay.
• Facilitate interdisciplinary team collaboration and liaison with patient, physician, payor, family.
• Expertise in acute care nursing, reimbursement requirements, and outcome data analysis.
• Promote care coordination and resource utilization across the health care continuum.

Skills

Interpersonal skills

Negotiation

Conflict resolution

Communication skills

Clinical case management

Computer skills

Education

BSN

Ohio RN license

Clinical specialty certification (preferred)

Tools

InterQual ISD-A

Milliman Guidelines

Job description

Facility: Miami Valley Hospital

The Case Manager is a registered nurse responsible for individualized patient assessment and care coordination, and transition planning to promote maximal outcomes in relation to appropriate length of stay, effective use of resources and established guidelines of care. Additional responsibilities include facilitation of interdisciplinary team collaboration, liaison between the patient, physician, payor, family/significant others in regards to care coordination and transitional care needs. This position requires expertise in acute care nursing, healthcare reimbursement requirements, clinical outcome data analysis, utilization management, transition planning and process, resource allocation, team management and communication skills. Promotes care coordination and effective utilization of resources through the assessment of patient care needs during the hospitalization and across the health care continuum. Success is measured against achievement of targeted goals and outcomes as generated by defined expectations through care team collaboration.

General Summary/Responsibilities

STATUS: Full-Time / 80h per pay period

Shifts: 0830-1700

Facility: Miami Valley Hospital

The Case Manager is a registered nurse responsible for individualized patient assessment and care coordination, and transition planning to promote maximal outcomes in relation to appropriate length of stay, effective use of resources and established guidelines of care. Additional responsibilities include facilitation of interdisciplinary team collaboration, liaison between the patient, physician, payor, family/significant others in regards to care coordination and transitional care needs. This position requires expertise in acute care nursing, healthcare reimbursement requirements, clinical outcome data analysis, utilization management, transition planning and process, resource allocation, team management and communication skills. Promotes care coordination and effective utilization of resources through the assessment of patient care needs during the hospitalization and across the health care continuum. Success is measured against achievement of targeted goals and outcomes as generated by defined expectations through care team collaboration.

Education: BSN required.

Licensure: Registered Nurse with valid Ohio license.

Certification: Certification in area of clinical specialty preferred.

Experience: Minimum of three years of relevant clinical experience in area of patient population within last five years. Expertise in healthcare reimbursement, transition planning and case management preferred. Experience with a clinical documentation management program preferred, knowledge of performance improvement process preferred.

Skills/Other: Exemplary interpersonal skills as demonstrated by the ability to develop and maintain rapport with physicians and Integrated Care Team members. Negotiation skills, conflict resolution skills and assertive communication skills required. Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements preferred. Experience in gathering information, monitoring indicators and feedback mechanisms required. Basic computer skills required.