Care Management RN

OVERVIEW At Redeemer Health, we offer nurses the opportunity to choose their preferred clinical setting, be it in our hospital, home care services, or senior care communities. As a part of our team, you'll be a respected clinical expert within our diverse workforce that spans southeastern Pennsylvania and New Jersey. We are committed to your professional growth, providing robust benefits, educational assistance, nursing scholarship opportunities, and a unique onboarding program that sets you up for long-term success and familiarizes you with our mission and celebrated service orientation. Join Redeemer Health to enrich your career, touch lives, and contribute to a mission rooted in service and compassion. Together, let's drive excellence in healthcare. SUMMARY OF JOB Under the general supervision of the Director, this position supports the delivery of effective and efficient patient care and is accountable for the utilization management and the transition management for patients within assigned caseload. The Care Management Nurse collaborates with other health care team members to identify appropriate utilization of resources, using criteria to confirm medical necessity for admission and continued stay. The incumbent provides initial, concurrent and retrospective reviews per payer requirements and completes the process with documentation to ensure complete information is provided to the Denials Coordinator and Corporate Business Office team for claim and appeal processing. This position provides psycho-social, emotional and educational support to the patient and family. Along with the patient, family and health care team creates a discharge plan appropriate to the patient's needs and resources. The Care Management Nurse serves as an advocate for the patient and family throughout the entire acute episode of care. CONNECTING TO MISSION : Every position and individual contribute to the Mission, Vision and Values of the Redeemer Health System. All have an ongoing responsibility for ensuring that the values of Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship and Collaboration are present in our interactions with one another and in the services provided. RECRUITMENT REQUIREMENTS Licensed RN; BSN preferred Three to 5 years nursing experience, acute care experience preferred Minimum two years of experience in healthcare setting preferred Prior experience in Care, Utilization or Transitional Management preferred Previous experience with discharge planning or home care experience, evaluation and assessment skills Critical thinking, sound problem-solving, collaboration with multiple team members Working knowledge of managed care and third-party reimbursement processes Organizational skills and ability to work independently. Ability to establish priorities among multiple needs, meet deadlines and maintain standards of productivity. Knowledge of managed care admission process (i.e. verification of benefits, admissions notification). Excellent customer service orientation and strong interpersonal skills. Proficiency in computer skills required to include Word, Excel, Outlook Knowledgeable of community resources, services and support offerings On call responsibilities, holiday coverage requirements per department policy LICENSE AND REGULATORY REQUIREMENTS : Licensed RN, BSN preferred Redeemer Health is an equal opportunity employer. We prohibit discrimination in employment due to race, color, gender, religion, creed, national origin, age, sex, sexual orientation, gender identity or expression, disability veteran status or any other protected classification required by law. Learn More