Case Manager (RN) - Utilization Management
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At a glance
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Job overview
Prime Healthcare is hiring a Case Manager (RN) - Utilization Management. At Montclair Hospital Medical Center, a 106‑bed acute‑care, not‑for‑profit community hospital, the Case Manager (RN) will oversee quality and resource management for admitted patients, promoting cost containment and seamless care delivery across the continuum of care.
Key focus areas include Responsible for quality and resource management of all admitted patients, Promote cost containment and integrate health care providers for seamless delivery of care, and Perform holistic admission and concurrent review of medical records for necessity, intensity, and severity.
Successful candidates bring Registered Nurse License, Minimum 5 Years RN Experience, and At Least One Year Case Management Experience. Important skills include Basic Computer Skills, Intermediate Computer Skills, Case Management, Discharge Planning, and Nursing Management. Preferred (not required): Milliman Criteria, InterQual Criteria, and Acute Care Nursing.
Skills & qualifications
Skills
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Benefits
Full job description
Overview At Montclair Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community. As a member of the Prime Healthcare Foundation, Montclair Hospital Medical Center is actively seeking new members to join its award-winning team! Founded in 1973, Montclair Hospital, a 106-bed acute care, not-for-profit community hospital, received the “100 Top Hospital” in the nation award from IBM Watson Health, the Patient Safety Excellence award from Healthgrades®, and the Women's Choice Award® for America's Best Emergency Care. For more information visit Montclair-hospital.org
Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
Qualifications EDUCATION, EXPERIENCE, TRAINING
Required Qualifications:
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Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license
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At least one year experience in case management, discharge planning or nursing management
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Experience and knowledge in basic to intermediate computer skills. Preferred Qualifications:
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Five years of acute care nursing experience. preferred
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CCM or obtained within 1year
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Knowledge of Milliman Criteria and InterQual Criteria preferred.
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Current BCLS certificate, preferred Pay Transparency Montclair Hospital Medical Center offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $43.25 to $58.21 The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.
Employment Status Full Time Shift Days Equal Employment Opportunity Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf
Privacy Notice Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf
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