RN Case Manager
Company: Hudson Regional Hospital
Location: Secaucus
Posted on: March 7, 2025
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Job Description:
MUST HAVE A VALID REGISTERED NURSE LICENSE IN NEW
JERSEYDuties: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.Reviews all patient
charts within 24 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.Certifies/denies all non-managed care cases on a daily
basis. 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 Social Work 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.EDUCATION + EXPERIENCE REQUIREMENTS:B.S. in
Nursing from an accredited school, college or university.Active,
unrestricted RN licensed in the State of New Jersey. At least two
years direct patient care in an acute care hospital. 2 years
previous UM/ case management experience preferred.Critical thinking
and strong interpersonal skills.Ability to work independently and
collaboratively in a fast paced environment and to respond to the
constant changes evident in the health care setting.Good
organizational and time management skills required. Customer
service focus and patient advocacy a must.Ability to collaborate
successfully with professional staff, as well as patients, families
and community.Ability to work with multicultural populations and
peer groups. Computer literacy.Workmen's Comp, NF/MVA and CCM
certification a plus.CREDENTIALS + QUALIFICATIONS:Knowledge of
Utilization Review criteria to include Interqual and/or
Milliman.Knowledge and experience in Medicaid, Medicare, Managed
Care Review, communication and documentation requirements.Knowledge
in discharge planning and length of stay initiatives.Knowledge of
home care/discharge planning and referral process.
Keywords: Hudson Regional Hospital, New York , RN Case Manager, Executive , Secaucus, New York
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