Case Manager / Outcomes Manager

Virtua Health is a multi-hospital healthcare system and one of the largest employers in southern New Jersey. We are located just minutes from Philadelphia, with easy access to all major routes including: Routes 295, 38, 70, 73 and exits 4 and 5 on the New Jersey Turnpike. Virtua has four hospitals, two rehabilitation and nursing centers, outpatient health and surgery centers, home healthcare services, and the William G. Rohrer Center for Health Fitness, and employs 7,100 clinical and administrative personnel and 1,800 physicians as medical staff members. In 2006, the Philadelphia Business Journal named Virtua #1 in the "Best Places to Work in the Delaware Valley" contest. Virtua was honored in the 1,000-or-more-employees category and was the only health system in South Jersey to receive top honors. In 2005, Virtua was among the top three winners and among the top 15 in 2004. Responsible for the assessment, planning, implementation, monitoring and evaluation of case management services through the appropriate utilization of resources, determination of medical necessity and achievement of positive outcomes. Utilizes independent critical thinking and decision making to formulate individualized plans of care and address patient’s discharge needs. •Develops case management recommendations consistent with sound medical and financial management. Includes assessment of health needs, individualized case management plans, implementation, monitoring, and evaluation of case outcomes. Utilizes independence and critical thinking skills to arrange for health care services within the scope of available benefits. •Performs admission, concurrent, discharge planning and retrospective reviews to obtain and document an accurate clinical assessment, and make medical necessity and appropriate level of care determinations within professional license scope of practice. •Utilizes approved department “Decision Support Tools” as a resource to assist in the decision making process regarding acute inpatient services and care. Identifies and refers all inpatient cases which do not meet approved criteria and guidelines to the Physician Advisor for evaluation. Consults with Physician Advisor to discuss medical necessity, length of stay, and appropriateness of care issues. •Utilizes clinical assessment skills and knowledge of patient care to make decisions regarding appropriateness or medical necessity of services, and determine which cases should be referred to Physician Advisor for evaluation. •Channels services to network providers including transfer of out-of-network facilities. Coordinates necessary services with participating ancillary services providers and public agencies as appropriate. •Performs data entry and data collection (per policy/procedure) and utilizes the Inpatient Census Report to track, monitor and document hospital utilization, discharge planning, variance and outcomes. •Participates in Medical Management meetings as an active member of the medical management team. •Identifies and reports, delays in service, denials and quality of care issues per policy/procedure. •Is responsible for screening, assessment and coordination of care for members meeting protocols and criteria for Catastrophic and Targeted Case Management Programs. •Identifies and reports departmental operational issues and resource needs to the appropriate management staff. •Establishes and maintains professional rapport with providers, patients and public agencies. •Performs other duties as assigned. •Complies with required workplace safety standards. •Graduate of an accredited School of Nursing and licensure as a Registered Nurse in the State of New Jersey or Graduate of an approved School of Social Work with a Bachelor’s or Master’s Degree and licensure and/or certification from the State of New Jersey as a Social Worker. LGPN enrolled in RN program and is expected to have RN license within 1 year from date of hire. •Minimum 3 years clinical nursing (RN or LGPN) experience and minimum 1 year UR/CM/QM experience or minimum 3 years experience as Social Worker in a Case management role. •Critical care, OB, PEDS, or QM background. •Discharge planning, home health background. •Certification in Case Management and/or Certification in Utilization Review (CPUR) preferred. •Basic understanding of Medicare, Medicaid and managed care. •Excellent verbal and written communication skills, problem solving, and conflict resolution. Virtua Health offers a competitive salary and excellent benefits, including: Health and Dental benefits, Prescription Plan, Domestic Partner coverage, Life Insurance, 401(K) savings plan, evening and night shift differentials, Paid Time Off (PTO), Extended Sick Time (EST), Flexible Spending Accounts, Direct Deposit, choice of 2 Credit Unions, hospital discounts, and Virtua employee childcare center - located on our Voorhees campus, and more. Please apply via www.virtua.org: Job Posting: "Outcomes Manager" To Apply for this position, please CLICK HERE As a Caring Culture, Virtua provides a supportive, rewarding environment that allows every member of the Virtua team to experience personal and professional growth, while achieving an important work/life balance. Our benefits reflect those values, offering an enriching program that includes everything from generous 401(k)* and medical coverage options to education reimbursement and wellness programs (Tobacco-free campuses, etc). * RN retirement benefits are provided in accordance with nursing union contracts. Job Title: Case Manager / Outcomes Manager Company: Virtua Health Location: Mount Holly, NJ 08060 Status: Full Time, Employee Job Category: Medical/Health Career Level: Manager (Manager/Supervisor of Staff) Company: Virtua Health Address: Mount Holly, NJ 08060 Reference Code: 1205505MON