CASE MANAGER-ADN

Premier Health; Ohmer Park (OH); On-site; USD 80,000 - 90,000; Full time

Job summary

Premier Health's Miami Valley Hospital is seeking a Case Manager (RN) to lead individualized care coordination and transition planning. You will work with the Integrative Care Team to optimize outcomes, manage resources, and coordinate with physicians, payors, and families.

The role requires acute care nursing expertise and knowledge of reimbursement, with 1–3 years of relevant experience. Ohio RN licensure and preferred certifications are required.

Qualifications

• RN with Ohio license; case management experience preferred.
• 1–3 years clinical experience in the last five years.
• Experience with discharge planning and clinical documentation systems preferred.

Responsibilities

• Coordinate patient care and transitions to optimize length of stay.
• Collaborate with care teams and liaise with physicians, payors, and families.
• Apply reimbursement requirements and guidelines to support planning.

Skills

Interpersonal skills

Negotiation skills

Conflict resolution

Assertive communication

InterQual ISD-A knowledge

Milliman Guidelines knowledge

Education

Associate's degree in Nursing

RN license - State of Ohio

Tools

InterQual ISD-A

Milliman Guidelines

Job description

Case Manager (RN), ADNIntegrated Care Management (ICM)Full Time 8:30am - 5pm / 80 Hours per PayMiami Valley HospitalThe 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: Associate's degree in Nursing from an accredited school of NursingLicensure/Certification/Registration: Valid RN license with the State of Ohio. Certification in area of clinical specialty (case management, neuro, critical care, rehab) is preferred.Experience: Minimum 1-3 years of relevant clinical experience in area of patient population within the last five years. Experience with clinical documentation management program preferred. Expertise in healthcare reimbursement, discharge planning and case management preferred.Knowledge/Skills:Exemplary interpersonal skills as demonstrated by the ability to develop and maintain rapport with physicians and Integrative 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 preferredKnowledge of Microsoft Office is required