Premier Health

Regional hospital network delivering comprehensive care

Case Manager - Nursing

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours

Full-timeDayton, OH, USANo salary listedIn-person

About the Job

Requirements

A Bachelor of Science in Nursing degree is required.
A Registered Nurse license valid in Ohio is required.
At least three years of relevant clinical experience with the applicable patient population within the last five years is required.
Expertise in acute care nursing, healthcare reimbursement requirements, clinical outcome data analysis, utilization management, transition planning, resource allocation, and communication is required.
Negotiation, conflict resolution, assertive communication, information gathering, indicator monitoring, and feedback-mechanism skills are required.
Basic computer skills are required.

Responsibilities

Perform individualized patient assessments and coordinate care and transition planning to promote optimal outcomes, appropriate length of stay, effective resource use, and adherence to established care guidelines.
Facilitate interdisciplinary team collaboration and serve as a liaison among patients, physicians, payors, families, and significant others regarding care coordination and transitional care needs.
Promote care coordination and effective resource utilization by assessing patient care needs during hospitalization and across the healthcare continuum.
Work with the care team to achieve targeted goals and outcomes defined by established expectations.

Desired Qualifications

Certification in a clinical specialty is preferred.
Expertise in healthcare reimbursement, transition planning, and case management is preferred.
Experience with a clinical documentation management program is preferred.
Knowledge of performance improvement processes is preferred.
Knowledge of InterQual ISD-A, Milliman Guidelines, and third-party insurance requirements is preferred.

General Summary/Responsibilities:

STATUS: Full-Time / 80h per pay period

Shifts: 0830-1700

Facility: Miami Valley Hospital

The Case Manager is a registered nurse responsible for individualized patient assessment and care coordination, and transition planning to promote maximal outcomes in relation to appropriate length of stay, effective use of resources and established guidelines of care. Additional responsibilities include facilitation of interdisciplinary team collaboration, liaison between the patient, physician, payor, family/significant others in regards to care coordination and transitional care needs. This position requires expertise in acute care nursing, healthcare reimbursement requirements, clinical outcome data analysis, utilization management, transition planning and process, resource allocation, team management and communication skills. Promotes care coordination and effective utilization of resources through the assessment of patient care needs during the hospitalization and across the health care continuum. Success is measured against achievement of targeted goals and outcomes as generated by defined expectations through care team collaboration.

Education: BSN required.
Licensure: Registered Nurse with valid Ohio license.
Certification: Certification in area of clinical specialty preferred.
Experience: Minimum of three years of relevant clinical experience in area of patient population within last five years. Expertise in healthcare reimbursement, transition planning and case management preferred. Experience with a clinical documentation management program preferred, knowledge of performance improvement process preferred.
Skills/Other: Exemplary interpersonal skills as demonstrated by the ability to develop and maintain rapport with physicians and Integrated Care Team members. Negotiation skills, conflict resolution skills and assertive communication skills required. Knowledge of InterQual ISD-A and Milliman Guidelines and third party insurance requirements preferred. Experience in gathering information, monitoring indicators and feedback mechanisms required. Basic computer skills required.

About the Company

Premier Health

Regional hospital network delivering comprehensive care

Premier Health operates a regional healthcare system in the Dayton, Ohio area that includes hospitals, emergency centers, and a wide range of primary and specialty care clinics. It delivers medical services through a connected network of hospitals, physicians, and affiliated providers, coordinating patient care across different settings. Revenue comes from patient care services, health plans, and partnerships with other healthcare organizations. The network’s approach emphasizes accessible, coordinated care for the Southwest Ohio community. Its goal is to improve community health by providing integrated, comprehensive care through its hospitals, clinics, and physician groups.

Company size: Not listed
Company stage: Not listed
Total funding: Not listed
Headquarters: Columbia, SC
Founded: 1995

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