Case Manager RN - Social Work Services

Prime Healthcare; Denville, Northern (NJ, KY); Hybrid; USD 84,000 - 104,000; Full time

Benefits offered by this job

401K retirement plan

Paid time off

Medical, dental, and vision coverage

Job summary

Saint Clare's Health, part of Prime Healthcare, seeks an experienced Registered Nurse to manage quality and resource use for admitted patients from admission through discharge.

The role emphasizes leadership, collaboration with care teams, adherence to criteria (Milliman/InterQual), and development of cost-conscious, patient-centered care plans. CCM credential within a year preferred; strong communication skills required.

Qualifications

• Must hold a current state RN license.
• Minimum 5 years' nursing experience post-graduation.
• At least 1 year in case management, discharge planning, or nursing management.
• CCM or CCM within 1 year preferred.

Responsibilities

• Quality and resource management for all admitted patients from admission through discharge.
• Promote cost containment and coordinate care across providers to ensure seamless delivery.
• Review medical records for medical necessity, intensity of service, and severity of illness.

Skills

RN license

Case management

Discharge planning

Leadership

Education

BSN

CCM within 1 year

Tools

Milliman Criteria

InterQual Criteria

Job description

Overview

At Saint Clare's Health, our dedicated team of professionals is committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, Saint Clare's Health is actively seeking new members to join its award-winning team!

Saint Clare's Health includesCMS 5-Star Ratedhospitals and is an award-winning provider of safe, high quality, compassionate care, serving the communities of Morris, Warren and Sussex counties. Its network of hospitals and healthcare facilities include Denville Hospital, Dover Hospital, Behavioral Health Centers in Boonton, Denville, and Parsippany, and an Imaging Center in Parsippany, among other satellite locations. The hospitals have received multiple quality awards including Leapfrog "A" ratings for patient safety; Healthgrades recognition for orthopedic surgery, treatment of stroke, heart care, various surgical procedures, and more. For information, visit www.saintclares.com.

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required Qualifications:

1. Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license2. At least one year experience in case management, discharge planning or nursing management3. Experience and knowledge in basic to intermediate computer skills.Preferred Qualifications:

4. Five years of acute care nursing experience. preferred5. CCM or obtained within 1year6. Knowledge of Milliman Criteria and InterQual Criteria preferred.7. Current BCLS certificate, preferred

Pay Transparency

Saint Clare's Health offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $84,926.40 to $104,000.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights:https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf