RN Case Manager-Philadelphia PA

Overview

Our client is a 188-bed facility that provides exceptional care to
children throughout the Greater Philadelphia area and surrounding
counties. We have more than 220 pediatric experts on staff, combining top-notch
pediatric care with a wide array of pediatric specialties including
Cardiology, Ear, Nose and Throat, Gastroenterology, Oncology, and
Orthopedics. It houses the only Verified Pediatric Burn Center between
New York City and Baltimore and is one of only three Level I Pediatric
Trauma Centers in Pennsylvania.

Responsibilities:

The Case Manager coordinates, manages and procures the discharge needs of patients identified as requiring post acute care services via initial admission screen, assessment and consults. This is achieved by collaboration with the family, the care team including physicians, nursing and other healthcare professionals. The Case Manager performs daily utilization review and conveys pertinent telephonic information to third party payers to secure appropriate acute care reimbursement within the time requirements of the payer. The Case Manager appeals 100% of all third party payer denials for acute care reimbursement according to the guidelines for the PA Region. The Case Manager performs ongoing PI/QA during concurrent review to identify quality of care issues, risk management issues, and performs blood/blood products and medication utilization.

Qualifications:

Education Requirements

4 year/bachelor's degree

Experience

Relevant Experience

Certification and Licensure

PA Registered Nurse License

Required Skills

Computer Skills to include use and navigation.
Excellent Communications Skills
Excellent Interpersonal Skills
Microsoft Word