Recognized for Excellence. Chosen for Caring.
Human Resources: 700 Lawn Avenue, Sellersville, PA 18960  |  215-453-4874
Registered Nurse (RN) - Resource Case Manager
Full Time, 9am-5:30pm, Monday-Friday
Sellersville, PA 18960
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Grand View Health is a leader in the healthcare community, recently earning an “A” Grade for Patient Safety from The Leapfrog Group. Located in Upper Bucks County, Grand View Health is a well-established, independent hospital offering a full range of healthcare services. Our employees enjoy the best of both worlds by working for a top-ranked hospital in a collaborative, community environment. Grand View Health: Recognized for excellence, chosen for caring.
 

Responsibilities

The Resource Case Manager will intervene with department staff, Patient Accounting, HIM, Patient Registration, MIS, Nursing and physicians to improve clinical and financial outcomes. Will monitor and assist Case Management staff to ensure LOS, coordination of care and safe DC planning occurs. Optimizes third-party reimbursement by managing real-time denials based on status, medical necessity and the plan of care. Ensures compliance for government and payor audit activity. Works with the Appeal Coordinator and performs case reviews and audits related to denials and appeals. Performs duties under the supervision of the Supervisor of Case Management.
 

Qualifications

  • RN.
  • BSN with 3-5 years of acute care case management and denial management experience preferred.
  • Working knowledge of utilization management, denial management, DC planning and care coordination is required.
  • Core knowledge of payor/CMS/DOH/JC regulations, compliance, reimbursement, billing, case management software and Microsoft Office (Excel) is preferred.
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Grand View Health is an equal opportunity employer.
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