Job Description
Assesses the needs of individual patients within an assigned case load for care coordination, discharge planning, and utilization management services Facilitates early referral to high risk case management, physical therapy, occupational therapy, social work, risk management, patient advocacy, post-acute services, and quality management.
Refers clinical issues and lapses in standards of care to appropriate parties.
Creates case management care plans for assigned patients. Comprehensively assesses patients’ requirements for services.
Extensively assesses patients’ organizational, and payer needs with regard to meeting clinical and financial goals, and patient / provider satisfaction.
Facilitates multi-disciplinary collaboration. Collaborates with colleague case managers in providing coordination of care.
Works with a multi-disciplinary team to develop a treatment plan, including contingency plans. Contributes to problem solving within the team through communication, collaboration, data collection, obtaining consensus, and evaluating outcomes of treatment options.
Implements strategies for case management care plans.
Qualifications
Licensure as a Registered Nurse (RN) in the state of Maryland, or eligibility for licensure is required. Bachelor’s degree is also required.
A health related Master’s degree and certification as case manager are both preferred.
One year of experience in case management and knowledge of payer mechanisms and clinical utilization management is preferred.
Two years experience in acute care required, four years clinical nursing experience preferred. Additional experience in home health, ambulatory care, and / or occupational health is preferred.
Additional Information
All your information will be kept confidential according to EEO guidelines.
UTILIZATION REVIEW / CASE MANAGEMENT RN - Part Time, Weekends
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