CASE MANAGER - North Campus

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

Job summary

Premier Health Partners is seeking a Case Manager (RN) at Miami Valley Hospital North in Dayton, Ohio. The RN will assess patients, coordinate care, and plan transitions to optimize outcomes, length of stay, and resource use within established care guidelines.

The role requires an Ohio RN license and BSN; certification in specialty areas is preferred. At least three years of relevant experience is expected, with some background in documentation management and reimbursement processes.

Qualifications

• RN license in Ohio is required.
• BSN is required.
• Three years of clinical experience in the relevant patient population in the last five years preferred.
• Experience with clinical documentation management programs preferred.
• Healthcare reimbursement, discharge planning and case management expertise preferred.
• Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements is preferred.

Responsibilities

• Assess patients and coordinate individualized care and transition planning to optimize stays and resource use.
• Lead interdisciplinary team collaboration and act as liaison among patient, physician, payor and family for care coordination.
• Promote care coordination and efficient use of healthcare resources across hospitalization and the continuum.

Skills

Interpersonal skills

Negotiation

Conflict resolution

Assertive communication

Microsoft Office

Reimbursement knowledge

Education

BSN

Job description

Position: Case Manager (RN)

Dept: Integrated Care Management Program

Shift: Full Time 8:30am -5pm / 80 Hours per Pay & every 4th weekend requirement

Facility: Miami Valley Hospital North

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: Graduate from an accredited school of nursing; BSN Required.

Licensure/Certification/Registration: Valid RN license with the State of Ohio; Certification in area of clinical specialty (case management, neuro, critical care, rehab) preferred.

Experience: Minimum of three 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 preferred,
• Knowledge of Microsoft Office is required