CASE MANAGER

Premier Health; Dayton (OH); On-site; USD 70,000 - 90,000; Full time

Job summary

Premier Health, Miami Valley Hospital in Dayton, OH, seeks an experienced Case Manager (RN). You will perform individualized patient assessment, care coordination, and transition planning to optimize length of stay and resource use.

You will liaise with physicians, payors, families, and care teams, use InterQual ISD-A and Milliman guidelines, and contribute to performance improvement. BSN and Ohio RN license required; 3+ years of clinical case management experience preferred.

Qualifications

• BSN required and Ohio RN license.
• 3+ years of relevant clinical case management experience.
• Familiarity with InterQual ISD-A and Milliman guidelines preferred.

Responsibilities

• Assess patient care needs and coordinate comprehensive discharge planning during hospitalization and through the health care continuum.
• Facilitate interdisciplinary team collaboration and liaise with physicians, payors, families, and care team members.
• Apply clinical expertise in utilization management, transition planning, and resource allocation to achieve target outcomes.

Skills

Interpersonal skills

Negotiation

Conflict resolution

Assertive communication

Clinical data analysis

Education

BSN

Ohio RN license

Specialty certification (preferred)

Tools

InterQual ISD-A

Milliman Guidelines

Job description

## CASE MANAGERDAYTON, OHIO, UNITED STATESApply NowUse AI to find out how well you match with this jobJob ID: 112091Facility: Miami Valley HospitalCategory: Nursing| || --- || 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.