Basic Qualifications:

Experience

Minimum two (2) years of RN experience in patient care delivery or completion of Masters degree in Case Management Program in lieu of minimum years of experience.

Education

License, Certification, Registration

Additional Requirements:

Demonstrated advanced communication and interpersonal skills with all levels of internal & external customers, including but not limited to medical staff, patients and families, clinical personnel, support and technical staff, outside agencies, and members of the community.
Ability to collaborate effectively with multidisciplinary healthcare team.
Excellent time management skills with the ability to work successfully in a fast-paced environment. Must be self-directed, and have the ability to tolerate frequent interruptions and a demanding work load.
Functional knowledge of computers.
Experience with managed health care delivery including Medicare.
Experience in a payer environment highly desirable.
Knowledge of funding, resources, services, clinical standards, and outcomes is preferred.
Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations.
Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations.
Knowledge of healthcare benefits associated with various business lines.

Preferred Qualifications:

Minimum five (5) years of clinical nursing experience in a hospital setting.
Minimum five (5) years of professional practice experience in an acute care setting.
Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
Bachelors Degree in Nursing, Health Care or Masters degree in Case Management.
Complex Case Management Certification preferred.

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