Case Manager (RN ) - Utilization Management

Overview Montclair Hospital Medical Center is 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 At Montclair Hospital Medical Center, our dedicated team of professionals are committed to our core values of quality, compassion, and community! Why Prime Healthcare? Montclair Hospital Medical Center is a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. Our Total Rewards package includes, but is not limited to : Paid Time Off 401K retirement plan Outstanding Medical Dental Vision Coverage Tuition Reimbursement Many more Voluntary Benefit Options! Benefits may vary based on collective bargaining agreement requirements and / or the employment status, i.e. full-time or part-time. This is a Fast-paced work environment in which you can take pride in serving an underserved community. Come Join a Team of Dedicated Healthcare Workers Montclair Hospital Medical Center is nationally recognized, locally preferred, and community focused. 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 insure 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 Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license. Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred. Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred. Current BCLS (AHA) certificate, preferred. Knowledge of Milliman Criteria and InterQual Criteria preferred. Experience and knowledge in basic to intermediate computer skills. 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 $50.00. 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 Per Diem 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