CASE MANAGER

Premier Health; Nine Mile Falls (WA); On-site; USD 72,000 - 95,000; Full time

Job summary

Premier Health is seeking a registered nurse for a full-time Case Manager role at Miami Valley Hospital. You will assess patients, coordinate care, and plan transitions to maximize outcomes and appropriate length of stay.

Requires a BSN and an Ohio RN license, with 3+ years of clinical experience. Certification in a clinical specialty is preferred, with strong team collaboration and care coordination skills.

Qualifications

• BSN required.
• Registered Nurse with an Ohio license.
• Clinical specialty certification preferred.
• Minimum of three years of relevant clinical experience.
• Experience with healthcare reimbursement and case management preferred.
• Knowledge of InterQual ISD-A and Milliman Guidelines preferred.

Responsibilities

• Assess patient needs and coordinate care across the hospital and continuum.
• Facilitate transitions to promote optimal outcomes and resource use.
• Collaborate with interdisciplinary team and liaise with physicians, payors, and families.
• Utilize performance data and care management processes to meet goals.

Skills

Interpersonal skills

Negotiation

Conflict resolution

Assertive communication

Care-team communication

Education

BSN

Ohio RN license

Clinical specialty cert

Tools

InterQual ISD-A

Milliman Guidelines

Documentation systems

Job description

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.