Registered Nurse - Case Management

Prime Healthcare; Bristol Township (Bucks County); On-site; USD 40,000 - 65,000; Part time

Job summary

Lower Bucks Hospital, part of Prime Healthcare, is seeking a Part Time RN Case Manager to oversee quality and resource management for admitted patients. The role involves advocacy for cost containment and coordinating care across the continuum, with emphasis on medical necessity reviews.

Required are 5 years post-graduation nursing experience and an active RN license; discharge planning and case management experience are preferred for this shift of days.

Qualifications

• 5 years post-graduation nursing experience
• Current RN license in state
• 5 years acute care nursing experience preferred
• At least 1 year in case management, discharge planning, or nursing management
• BCLS (AHA) certificate preferred
• Knowledge of Milliman criteria and InterQual criteria preferred
• Basic to intermediate computer skills

Responsibilities

• Oversee quality and resource management for all admitted patients across the care continuum
• Advocate for cost containment and lead integration of health care providers
• Perform comprehensive admission and concurrent reviews for medical necessity, intensity of service, and severity of illness

Skills

Discharge planning

Case management

Acute care nursing

BCLS (preferred)

Computer skills

InterQual/Milliman criteria knowledge

Education

Registered Nurse license (RN)

Tools

Electronic Medical Records

Job description

Overview

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Lower Bucks Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Lower Bucks Hospital is a community hospital, serving the Lower Bucks County region with medical, surgical, and emergency care. Located in historic Bristol, Pennsylvania, the Hospital is well-known for its knowledgeable medical staff, including cardiology, orthopedics, radiology, wound care, and general surgery. The hospital has more than 200 physicians on staff, as well as another 700 employees.

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 insure 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 and Work Experience

• Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license
• Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.
• Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.
• Current BCLS (AHA) certificate, preferred.
• Knowledge of Milliman Criteria and InterQual Criteria preferred.
• Experience and knowledge in basic to intermediate computer skills.
• Behavioral Violence Prevention Training within 3 months of hires and maintain current.

Employment Status

Part Time < 60

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