RN Case Manager

Hudson Regional Health; Secaucus (NJ); On-site; USD 100,000 - 110,000; Full time

Job summary

Hudson Regional Health in Secaucus, NJ is seeking an experienced RN Case Manager for a full-time, non union role. The position provides case management and discharge planning to facilitate safe, timely discharges, optimize care transitions, and support hospital reimbursement.

Responsibilities include chart reviews within 24–48 hours, coordinating with physicians and insurance providers, participating in interdisciplinary rounds, and liaising with departments to shorten length of stay and ensure

Qualifications

• Current RN license in NJ.
• 1–2 years direct patient care in an acute care hospital.
• Knowledge of utilization review criteria and hospital reimbursements.

Responsibilities

• Reviews patient charts within 24–48 hours of admission to assess admission appropriateness and discharge needs.
• Communicates with attending physician and, if unresolved, refers cases to Physician Advisor.
• Contacts insurance providers for admission and stay reviews to certify stays and assist with reimbursement.
• Directs attention to denied day cases and refers them to Physician Advisor.
• Participates in Interdisciplinary D/C Rounds to review plan of care and improve care.
• Keeps the Director of Case Management updated on problems and seeks guidance.
• Coordinates care with ancillary departments to shorten length of stay and ensure appropriate treatment and discharge.

Skills

Utilization Review

Medicaid/Medicare

Discharge planning

Home care referrals

Critical thinking

Communication skills

Education

NJ RN License

1-2 years acute care experience

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

RN Case Manager

Full Time Non Union Secaucus, NJ, US

30+ days ago Requisition ID: 3662

Salary Range: $100,000.00 To $110,000.00 Hourly

Position Summary

Provides case management as well as routine discharge planning services to patients and their families, to facilitate safe and timely discharges, to enhance the benefits of medical care, to ensure hospital reimbursement, to provide cost effective acute care and to ensure continuity of care.

Job Duties

• Reviews all patient charts within 24 to 48 hours of admission to assess appropriateness of admission, intensity of service and potential discharge needs in accordance with the utilization/contractual requirements.
• All questionable cases (i.e. inappropriate admission, level of care changes, quality issues) will be communicated to the Attending Physician. If no resolution, CM will refer the cases to the Physician Advisor.
• Communicates with insurance providers for admission and continued stay reviews as stipulated by contract in order to certify the patients' stays. Contacts the Attending Physician to obtain additional clinical information on the case to minimize denials and to assist with reimbursement of care and/or appeals.
• Denied day cases will automatically be referred to the Physician Advisor.
• Participants in Interdisciplinary D/C Rounds to concurrently and collaboratively review and facilitate the patient's plan of care. Acts as liaison to assist in identifying opportunities to improve care.
• Keeps Director of Case Management abreast of problem areas and seeks guidance in a timely manner.
• Effectively coordinates care with ancillary departments and attending physician (i.e. rehabilitation, laboratory, radiology, etc.) to ensure timely provision of care and to decrease length of stay and appropriate treatment and discharge.
• Performs other job duties and responsibilities asassigned.

Qualifications and Skills

• Knowledge of Utilization Review criteria to include Interqual and/or Milliman preferred .
• Knowledge in Medicaid, Medicare, Managed Care review and documentation requirements. Is knowledgeable of state and federal regulations, DNV standards and practices for acute care facilities.
• Excellent written and verbal communication skills.
• Knowledge in discharge planning and length of stay initiatives.
• Knowledge of home care and referral process.
• Expert critical thinking and problem solving skills.

Education, Experience and Certification/Licensure Requirements

• Current RN license in the state of NJ.
• Minimum 1- 2 years direct patient care experience in an acute care hospital