An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. Seeks out and resolves discrepancies and delays in the care delivery process, identifies positive and negative care trends and process obstacles Performs the primary role functions of assessment, planning, facilitation and advocacy, which are achieved through collaboration with the patient and those involved in the patient's care. Assures that appropriate services are generated in a timely and cost-effective manner by assisting the patient to appropriately self-direct care, self-advocate, and make informed healthcare decisions to the highest degree possible. Responsibilities include, but are not limited to: positive relationship building, effective written/verbal communications; negotiation; knowledge of contractual or risk arrangements; and ability to effect change, perform ongoing evaluation and critical analysis, plan and organize effectively and promote client/family autonomy. Conducts admission and continued stay review on patients, in accordance with the PPO and/or HMO contracts, InterQual and other classifications as designated by the Utilization/Case Management Review Plan. Identifies trends and patterns of resource use and patient care, and makes recommendations in compliance with established policy and procedure. Ensures continuity of care for patients with post-hospital health care needs and maximizes the patient's and family's abilities to meet the continuing care needs within their social and financial framework. Understands and applies the principles of growth and development to assess a patient's age specific needs to ensure appropriate treatment and care.
Minimum of one year experience in Case Management/Utilization Management or Home Care.Minimum of 1 year hospital experience.Successful completion of all Orientation Programs
Welcome to Barnabas Health, New Jersey’s largest integrated health care delivery system. It includes Clara Maass Medical Center in Belleville; Community Medi...cal Center in Toms River; Kimball Medical Center in Lakewood; Monmouth Medical Center in Long Branch; Newark Beth Israel Medical Center in Newark; Barnabas Health Behavioral Health Center in Toms River; and Saint Barnabas Medical Center in Livingston. The System also includes the Barnabas Health Outpatient Centers with the Barnabas Health Ambulatory Care Center in Livingston and the Saint Barnabas Family Imaging and Breast Center in Bedminster; ambulatory care facilities, geriatric centers, a state-wide behavioral health network and comprehensive home care and hospice programs.Barnabas Health's 19,600 employees (second largest private employer in the state) and 4,750 physicians (one-fourth of N.J. practicing physicians), and 450 residents provide treatment and services for more than 225,000 inpatients and same day surgery patients, 451,000 Emergency Department patients and over 1.5 million outpatients each year, and deliver more than 17,500 babies annually.Among our nationally recognized services and facilities are New Jersey’s only certified burn treatment facility; world-class cardiac surgery services for adults and pediatrics; the state’s oldest, most experienced center for heart transplants, ranked in top 10 by volume in the nation; New Jersey’s only lung transplant program; two kidney transplant centers which are among the largest in the nation with 35 years of experience; six certified chest pain centers by the American Society of Chest Pain Centers; three Joint Commission-accredited Primary Stroke Centers, one Comprehensive state-accredited Stroke Center, and three state-accredited Primary Stroke Centers.Our renowned services also include the most comprehensive robotic surgery service in the region with cardiothoracic surgery, general surgery, adult and pediatric urology, gynecology, and gynecologic oncology; a highly respected neurology and neurosurgery program; a widely recognized reproductive medicine and science program; nationally recognized geriatric services; comprehensive cancer services, providing patients with state-of-the-art technology and cutting-edge treatment options through participation in clinical research trials; three Valerie Fund Children’s Centers for Cancer and Blood Disorders; renowned women’s and children’s services, including Children's Hospital of New Jersey at Newark Beth Israel Medical Center and The Children’s Hospital at Monmouth Medical Center; and New Jersey’s only neonatal ECMO program for life-support.Throughout Barnabas Health, our dedicated physicians, nurses and health professionals are committed to providing the highest quality of patient care and health education to the community and the region.