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.

At Inspira Health, you’ll join with the area’s most dedicated and distinguished team to bring quality and compassionate care to our communities. We focus on clinical excellence, providing evidence-based care to help each patient achieve the best possible outcome. The scope and depth of our network can open many doors for your learning and career growth.

Our charitable nonprofit health care organization serves communities across southern New Jersey. The network, which traces its roots to 1899, comprises three hospitals, a comprehensive cancer center, sleep medicine, cardiac testing, digestive health and wound care, urgent care, imaging and rehabilitation, and primary and specialty physician practices in Gloucester, Cumberland, Salem and Camden counties.

Inspira is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, religion, creed, color, national origin, ancestry, age, marital status, affectional or sexual orientation, familial status, disability, liability for service in the Armed Forces of the United States, nationality, sex, gender identity or expression.