What are the responsibilities and job description for the STC RN Case Manger position at Tower Health?
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 TENET 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
Experience
Certification and Licensure
Required Skills
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 TENET 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
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