Registered Nurse Care Manager – Utilization Management

Trinity Health; Darby (Delaware County); Vor Ort; USD 60.000 - 75.000; Teilzeit

Benefits dieser Stelle

Free parking

Comprehensive benefits

Zusammenfassung

Trinity Health Mid-Atlantic is seeking an RN Care Manager – Utilization Management for Mercy Fitzgerald. This per diem/weekend position supports care coordination, ensuring appropriate utilization and reimbursement with InterQual criteria.

The role involves collaboration with a multidisciplinary team and discharge planning expertise. The ideal candidate holds a BSN and PA RN licensure, with 3+ years of clinical experience and preferred Case Management certification.

Qualifikationen

• BSN required.
• Active RN license in PA required; Case Management certification preferred.
• Minimum of 3 years clinical experience with emphasis on medical/surgical nursing; Case Management, Discharge Planning, and Utilization Management preferred.
• Knowledge of managed care, InterQual criteria, and MIDAS system; proficient with Microsoft Office; strong communication; ability to document in EHR.

Aufgaben

• Perform utilization reviews to support efficient patient care.
• Apply InterQual criteria to confirm medical necessity for admission and continued stay.
• Collaborate with physicians, nurses, and other professionals to ensure appropriate resource use and reimbursement.
• Screen patients for Intensive Case Management programs, including disease management and discharge planning.
• Monitor patient progress and outcomes to support high-quality, cost-effective care.
• Document findings and interventions in the EHR and clinical databases.

Kenntnisse

InterQual criteria

Managed care knowledge

Communication skills

EHR documentation

Ausbildung

Bachelor of Science in Nursing

Tools

MIDAS system

Microsoft Office

Jobbeschreibung

Employment Type: Part time Shift: Weekend Shift Description: RN Care Manager – Utilization Management Location: Mercy Fitzgerald Department: Care Coordination Schedule: Per Diem/Weekends

Position Purpose

Mercy Fitzgerald is seeking a dedicated RN Care Manager – Utilization Management to join our Care Coordination team. Under the general supervision of the Manager of Care Coordination, this role supports the delivery of effective and efficient patient care by ensuring appropriate utilization of resources and reimbursement. The RN Care Manager is accountable for utilization management within an assigned caseload and collaborates with the healthcare team to confirm medical necessity for admission and continued stay.

What You Will Do

• Perform clinically based utilization reviews to support efficient patient care delivery.
• Apply InterQual criteria to confirm medical necessity for inpatient admission and continued stay.
• Collaborate with physicians, nurses, and other healthcare professionals to ensure appropriate resource use and reimbursement.
• Screen patients for Intensive Case Management programs, including disease management and discharge planning.
• Monitor patient progress and outcomes to support high-quality, cost-effective care.
• Document findings and interventions in the electronic health record and clinical databases.

Minimum Qualifications

• Education: Bachelors of Science in Nursing (BSN) required.
• Licensure/Certification: Active Registered Nurse license in the State of Pennsylvania required. Case Management certification from an accredited organization preferred.
• Experience: Minimum of 3 years of clinical experience, with emphasis on medical/surgical nursing. Experience in Case Management, Discharge Planning, and Utilization Management preferred.
• Skills: Knowledge of managed care, government payers, and third-party reimbursement. Familiarity with InterQual criteria and MIDAS system preferred. Proficiency in Microsoft Office applications. Strong interpersonal, oral, and written communication skills. Ability to document effectively in electronic health records.

Position Highlights

Be part of a mission-driven organization focused on quality and compassionate care. Collaborate with a multidisciplinary team to improve patient outcomes and resource efficiency. Opportunity for professional growth and certification in case management. Competitive compensation and comprehensive benefits package.

Benefits

• Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.
• Work/Life balance with flexible schedules.
• Free onsite parking.

Our Mission and Core Values

Our mission and core values are what drives each member of Trinity Health to support each other, communicate openly and respectfully while embracing a culture that nurtures a healing, safe environment for all.

Ministry/Facility Information

Trinity Health Mid-Atlantic was formed in October 2018 and is the largest Catholic healthcare system serving the Greater Philadelphia area and is a part of Trinity Health of Livonia, Michigan, and sponsored by Catholic Health Ministries. The hospitals and associated clinics, medical offices, specialized facilities, affiliated institutions and foundation represent more than 6,000 colleagues. These hospitals serve together in the spirit of the Gospel as a compassionate and transforming healing presence within their communities. Mercy Fitzgerald Hospital is a 178-bed teaching hospital located in Darby, Pa., which offers advanced acute care services in Delaware County and Southwest Philadelphia. Consistently recognized for clinical excellence, Mercy Fitzgerald is proud of our many quality achievements such as: Blue Distinction Center for Cardiac Care, Bariatric Surgery Center of Excellence, Achievement Awards from the American Heart/Stroke Associations and Certified Primary Stroke Center.

Commitment Rooted in our Mission and Core Values

We honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care.

Equal Opportunity Employer

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

About Trinity Health

Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. Together, we’re 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, our system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations, and many other health and well-being services. Based in Livonia, Michigan, in fiscal year 2023, we invested $1.5 billion in our communities through charity care and other community benefit programs. For more information, visit http://www.trinity-health.org. You can also follow Trinity Health on LinkedIn.