Case Manager, RN - Utilization Review

About the position

St. Francis Medical Center is seeking a dedicated and experienced Case Manager, RN for Utilization Review. This role is pivotal in ensuring the quality and resource management of all patients admitted to the facility, overseeing their care from the point of admission through the continuum of healthcare management. The Case Manager will act as an advocate for patients, promoting cost containment while demonstrating leadership to integrate healthcare providers for a seamless delivery of care. The position requires a holistic and comprehensive approach to admission and concurrent review of medical records, focusing on medical necessity, intensity of service, and severity of illness. As a member of the healthcare team, the Case Manager will collaborate with various departments to ensure that patients receive the appropriate level of care while also managing resources effectively. This includes conducting thorough assessments, developing care plans, and coordinating with healthcare providers to facilitate optimal patient outcomes. The Case Manager will also be responsible for educating patients and their families about their care plans and available resources, ensuring they are well-informed and supported throughout their healthcare journey. St. Francis Medical Center is committed to providing high-quality and compassionate medical care to the community it serves, and the Case Manager plays a crucial role in upholding these values. The ideal candidate will have a strong background in nursing, particularly in acute care settings, and possess excellent communication and organizational skills to navigate the complexities of patient care management.

Responsibilities
? Responsible for the quality and resource management of all patients admitted to the facility.
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? Promote cost containment and demonstrate leadership to integrate healthcare providers for seamless care delivery.
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? Facilitate and ensure the achievement of quality, clinical, and cost-effective outcomes.
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? Perform holistic and comprehensive admission and concurrent reviews of medical records for medical necessity, intensity of service, and severity of illness.

Requirements
? Current state Registered Nurse license with a minimum of 5 years work experience post-graduation from an accredited school of nursing.
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? Preferred: RN Case Manager with at least 5 years of acute care nursing experience and 1 year in case management or discharge planning.
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? Current BCLS (AHA) certification preferred.
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? Knowledge of Milliman Criteria and InterQual Criteria preferred.
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? Basic to intermediate computer skills.

Nice-to-haves
? Experience in case management, discharge planning, or nursing management.
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? Strong communication and organizational skills.

Benefits
? Health insurance
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? Dental insurance
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? 401(k)
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? Tuition reimbursement
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? Paid time off
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? Vision insurance

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