The Case Manager UM is responsible for review and management of utilization resources to ensure that the member is in the appropriate setting as well as within the scope of their benefit plan. The Case Manager provides clinically based case management to support the delivery of effective and efficient patient care in the inpatient and outpatient settings. The Case Manager is responsible for determining the appropriateness of care, development and coordination of a plan of care and communicating to appropriate parties the determination plans and coordination of identified services. The position also is engaged in follow up planning and adjusting care plans as needed. This candidate will be responsible for utilization management case management, working collaboratively with members of healthcare team to improve the efficiency and quality of patient care, and will demonstrate professional behavior in all aspects of job performance.
High School Diploma or GED
CERTIFICATION AND LICENSURE REQUIREMENTS:
PA REGISTERED NURSE LICENSE
4-5 years med/surg nursing experience
Excellent Communications Skills, Excellent Interpersonal Skills, Microsoft Word, Keyboarding