Trinity Health
RN Care Manager Utilization Management (Per Diem)
Trinity Health - Wilmington, Delaware, United States, 19805
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Overview
RN Care Manager
Utilization Management
Location: Saint Francis Hospital Department: Care Management / Utilization Review Schedule: Per Diem | 1 Weekend per Month/Vacation Coverage | 8hr shift Position Purpose: As a Case Manager in Utilization Management, you will be the key to ensuring patients receive appropriate, high-quality care. You'll assess medical necessity, collaborate with healthcare teams and payers, and streamline care plans to align with clinical and regulatory standards. By optimizing resource utilization and maintaining the highest standards of care, you will contribute to a more efficient and patient-focused healthcare experience. What You Will Do: Evaluate and determine clinical appropriateness of inpatient admissions and observation status in compliance with payer requirements, clinical guidelines, and organizational protocols. Communicate findings with physicians to ensure alignment with medical necessity standards. Work closely with physicians, nurses, and the admissions team to coordinate care and address clinical documentation needs for accurate case review and status determination. Oversee the continuity of care by developing comprehensive care plans, ensuring seamless transitions between levels of care, and optimizing discharge planning to prevent re-hospitalizations. Monitor and manage the utilization of clinical resources to ensure efficiency and cost-effectiveness while maintaining high-quality patient outcomes. Provide guidance to clinical teams on proper documentation practices to support reimbursement and compliance with regulatory requirements. Educate patients and families on care options, disease management, and anticipated outcomes, serving as a resource for navigating post-acute care services. Minimum Qualifications: Licensure:
Current Delaware RN license or eligibility for licensure. Experience:
Minimum 1 year of experience as an RN Case Manager in an acute care setting with a focus on Utilization Review.
Education:
BSN preferred. Certifications:
Willingness to obtain Case Management Certification (e.g., CCM or ACM) within one year of hire. Knowledge:
Proficiency in MCG and/or InterQual criteria. Familiarity with CMS regulations, including the Two-Midnight Rule and Observation vs. Inpatient criteria.
Position Highlights: Join a collaborative and mission-driven care management team. Opportunity to make a meaningful impact on patient outcomes and hospital performance. Supportive environment for professional growth and certification. Competitive compensation and comprehensive benefits package. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Utilization Management
Location: Saint Francis Hospital Department: Care Management / Utilization Review Schedule: Per Diem | 1 Weekend per Month/Vacation Coverage | 8hr shift Position Purpose: As a Case Manager in Utilization Management, you will be the key to ensuring patients receive appropriate, high-quality care. You'll assess medical necessity, collaborate with healthcare teams and payers, and streamline care plans to align with clinical and regulatory standards. By optimizing resource utilization and maintaining the highest standards of care, you will contribute to a more efficient and patient-focused healthcare experience. What You Will Do: Evaluate and determine clinical appropriateness of inpatient admissions and observation status in compliance with payer requirements, clinical guidelines, and organizational protocols. Communicate findings with physicians to ensure alignment with medical necessity standards. Work closely with physicians, nurses, and the admissions team to coordinate care and address clinical documentation needs for accurate case review and status determination. Oversee the continuity of care by developing comprehensive care plans, ensuring seamless transitions between levels of care, and optimizing discharge planning to prevent re-hospitalizations. Monitor and manage the utilization of clinical resources to ensure efficiency and cost-effectiveness while maintaining high-quality patient outcomes. Provide guidance to clinical teams on proper documentation practices to support reimbursement and compliance with regulatory requirements. Educate patients and families on care options, disease management, and anticipated outcomes, serving as a resource for navigating post-acute care services. Minimum Qualifications: Licensure:
Current Delaware RN license or eligibility for licensure. Experience:
Minimum 1 year of experience as an RN Case Manager in an acute care setting with a focus on Utilization Review.
Education:
BSN preferred. Certifications:
Willingness to obtain Case Management Certification (e.g., CCM or ACM) within one year of hire. Knowledge:
Proficiency in MCG and/or InterQual criteria. Familiarity with CMS regulations, including the Two-Midnight Rule and Observation vs. Inpatient criteria.
Position Highlights: Join a collaborative and mission-driven care management team. Opportunity to make a meaningful impact on patient outcomes and hospital performance. Supportive environment for professional growth and certification. Competitive compensation and comprehensive benefits package. Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.