About this role
MAJOR FUNCTION:
Facilitates a patient’s hospitalization from pre-admission through discharge. Collaborates with physicians, nurses, social workers and other members of the healthcare continuum to ensure appropriate, cost-effective care. Applies clinical expertise and medical necessity criteria to perform the functions of utilization management, care coordination, resource utilization, and discharge planning. Must utilize established criteria to review appropriateness of admission and continued stay. Perform initial and ongoing assessment to ensure a timely transitional care plan is developed that will support each patient’s needs and prevent hospital readmission. Identify and prevent potential barriers in transition of care. Ensure discharge plan is consistent with patient’s clinical course, continuing care needs, and covered services. Identify patients and/or families who require social work referral. Actively participate in multidisciplinary rounds. Collaborate with next level of care providers as appropriate.
QUALIFICATIONS:
Education & Experience:
- BSN required if hired after September 1, 2021. For Mannington only, all hired on or after June 1, 2023 have BSN required, or must enrolling a BSN program by 6 months of employment and obtain their BSN by their 3rd work anniversary in a BSN required position.
- Hired prior to BSN preferred, associate degree required.
- Minimum 3 years of experience in hospital setting required.
- 1-3 years of case management experience preferred.
- Clinical background in assigned unit/service line preferred.
- Previous utilization management experience preferred.
- Previous experience with regulatory and compliance requirements preferred.
Certification/Licensure:
- Licensed Registered Nurse in New Jersey required.
- Case Management Certification preferred.
Knowledge & Skills:
- Demonstrates excellent communication skills (oral and written) and interpersonal skills necessary to communicate with families, patients, interdisciplinary healthcare team members, vendors, and third-party payors for optimum care.
- Excellent clinical and administrative skills and judgement.
- Proficiency in Microsoft Office.
- Ability to work independently, setting priorities to coordinate care plans efficiently.
- Working knowledge of Milliman criteria preferred.
| Physical Requirements: N: Never O: Occasionally (<20%) F: Frequently (20%-80%) C: Constantly (>80%) | |||||
| Lifting <20lbs | F | Standing | F | Sitting | C |
| Lifting 20-50lbs | O | Climbing | O | Kneeling | O |
| Lifting>50lbs | N | Crouching | O | Reaching | F |
| Carrying | O | Hearing | C | Walking | F |
| Pushing | O | Talking | C | Vision | C |
| Environmental Conditions: | |||||
| Noise | F | Varied Temperatures | O | Cleaning Agents | O |
| Noxious odors | N | Patient Exposure | F | Operative Equipment | N |
BENEFITS INFORMATION:
Other facts
About Inspira Health
Inspira Health is a charitable nonprofit health care organization serving communities across southern New Jersey. The system traces its roots to 1899 and comprises three hospitals, two comprehensive cancer centers, eight multi-specialty health centers, and locations throughout South Jersey. These include urgent care; outpatient imaging and rehabilitation; sleep medicine labs; cardiac testing facilities; behavioral health, digestive health and wound care centers; home care and hospice; and more than 35 primary and specialty physician practices in Gloucester, Cumberland, Salem, Camden and Atlantic counties.
Together with our medical staff of more than 1,200 physicians and other health care providers, we provide evidence-based care to help each patient achieve the best possible outcome. Our clinical and support staffs are focused on providing quality care in a safe environment for every patient. And we understand that to provide excellent care to our patients, we must also be sensitive to the needs of their families. The love and support of family can comfort and strengthen patients while aiding the healing process.
In support of our mission to improve the lives of all we serve, the leadership and staff of Inspira Health are dedicated to clinical and service excellence. However, as a leading regional health network, we are committed to doing more than just that. We believe our organization must become a source of inspiration, encouraging everyone to lead healthier lives. This can only be achieved by working together with our communities; by bringing vital services to the towns and neighborhoods we serve; and partnering with like-minded organizations to create a culture throughout our region that fosters good health for everyone.
What you'll do
- Facilitates a patient’s hospitalization from pre-admission through discharge, ensuring appropriate and cost-effective care. Collaborates with healthcare team members to develop and implement care plans that support patient needs and prevent hospital readmission.
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