Case Manager

Job Title: Case Manager

Location: Newark Beth Israel Medical Center

Req#: 0000176342

Status: Per Diem

Shift: Day

Department name: Case Management

Job Overview:

The RN Case Manager Discharge Planner will be responsible for all aspects of case management for an assigned group of inpatients to determine the appropriateness of the continued stay, assist in the development of the plan of care; ensure that the plan is implemented promptly, and identify the expected length of stay, The RN Case Manager works collaboratively with the interprofessional team, including physicians, social workers, clinical nurses, home care services, and others as needed, This role actively participates in specific clinical initiatives focused on reducing the length of stay and continued stay denials, improves efficiency, quality, and resource utilization.

Qualifications:

Required:

Preferred:

Certifications and Licenses Required (if applicable):

Scheduling Requirements (non-exempt positions):

• Per Diem
• Day

Essential Functions:

• Timely admission review.
  Continued stay review performed concurrently. Applies knowledge of growth and development over the life span.
  Discharge review as necessary.
  Retrospective review as indicated.
  Application of Milliman Care Guidelines and Interqual criteria (severity of illness and intensity of service).
  Quality issues.
  Level of care changes (skilled, intermediate, custodial).
  Termination of benefits.
  Collaborates with physician advisor on level of care changes, denials, and communication issues with other physicians.
  Identification of inappropriate resource utilization.
  When issuing a letter to the patient/family concerning level of care changes, denial of days, etc., explains to the patient/family the UM process and federal regulations as they pertain to the individual case.
  Interfaces with third-party payers for the purpose of providing pertinent clinical data and for initiating and maintaining clear channels of communication to maximize reimbursement.
• Screens patients in the pre-admission and admission phase in a timely manner.
  Identifies patient, family and system issues through assessment on a continual basis and addresses issues as necessary (e.g., communicates with Utilization Management, Social Work).
  Applies knowledge of growth and development over the life span.
  Applies the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned caseload, i.e., Infant, Adult, Pediatric, Geriatric and Adolescent.
  Assess data reflective of each patient s status and interprets information needed in order to identify each patient s age requirements relative to his or her age specific health care needs.

Benefits and Perks:

At RWJBarnabas Health, our market-competitive Total Rewards package provides comprehensive benefits and resources to supports our employees physical, emotional, social, and financial health.

• Paid Time Off (PTO)
• Medical and Prescription Drug Insurance
• Dental and Vision Insurance
• Retirement Plans
• Short & Long Term Disability
• Life & Accidental Death Insurance
• Tuition Reimbursement
• Health Care/Dependent Care Flexible Spending Accounts
• Wellness Programs
• Voluntary Benefits (e.g., Pet Insurance)
• Discounts Through our Partners such as NJ Devils, NJ PAC, Verizon, and more!

Choosing RWJBarnabas Health!

RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in a compassionate and equitable manner, while delivering a best-in-class work experience to every member of the team. We honor and appreciate the privilege of creating and sustaining healthier communities, one person and one community at a time. As the leading academic health system in New Jersey, we advance innovative strategies in high-quality patient care, education, and research to address both the clinical and social determinants of health.

RWJBarnabas Health aims to truly make a unique impact in local communities throughout New Jersey. From vastly improving the health of local residents to creating educational and career opportunities, this combination greatly benefits the state. We understand the growing and evolving needs of residents in New Jersey whether that be enhancing the coordination for treating complex health conditions or improving community health through local programs and education.

Equal Opportunity Employer