Utilization Case Manager Jobs in Nebraska (NOW HIRING)

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Shift Start Time

Children's is one of the nation's leading children's hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We're committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children's.

Experience

• 3 years RN experience with a Bachelor of Science in Nursing (BSN)
• OR a current Children's nurse with 5 years RN experience with an Associate's degree in Nursing (Current Children's nurse with an Associate's degree in Nursing is required to obtain a BSN within 2.5 years of hire date)
• 3 years of broad clinical experience, predominantly in pediatric care

Preferred Qualifications

• Master's degree
• Previous experience in care coordination, case management, discharge planning and/or utilization review; pediatrics preferred

Education

• Graduation from an accredited school of nursing

Certification Summary

• Licensure as a Registered Nurse in the single State of Georgia or Multi-State through the Enhanced Nurse Licensure Compact
• Registered Nurse Case Management Certification from approved accrediting organization within 1 year of meeting eligibility requirements, within 2 years of hire for a 0.8 FTE or greater, or within 3 years of hire for a 0.6 FTE or less
• Basic Life Support (BLS) certification from the American Heart Association within 30 days of employment

Knowledge, Skills, and Abilities

• Excellent communication skills, both verbal and written
• Effective decision-making /problem-solving skills, demonstration of creativity in problem-solving, influential leadership skill
• Demonstrated effective critical thinking skills and ability to anticipate patient discharge needs
• Moderate to expert computer skills
• Working knowledge of the financial aspects of third-party payors and reimbursement
• Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating within 30 days of employment

Job Responsibilities

• Completes initial screen of all patients on admission (not to exceed within 24 hours of admission) utilizing specific trigger criteria to identify needs related to care coordination and/or discharge planning.
• Develops, initiates, and implements a robust transition care plan in collaboration with clinical team for all applicable patients.
• Cultivates and maintains effective interaction/communication with medical staff, nursing staff, social workers, and others to drive the care coordination process and facilitate continuity of patient care.
• Communicates with all members of the multidisciplinary team to facilitate the care coordination process for assigned workload.
• Communicates with home health agencies, third-party payors, and other community resources as needed to coordinate discharge needs.
• Facilitates and provides ongoing communication with patient/family and interdisciplinary staff to identify and resolve potential barriers.
• Facilitates care conferences, interdisciplinary rounds, and other meetings.
• Participates in focused system initiatives and facilitates clinical practice guidelines at the patient level.
• Performs outpatient and clinic care coordination and monitors patients' care as they transition between outpatient and inpatient services where appropriate.
• Refers cases identified as risk management issues, peer review issues, or quality issues to appropriate personnel.
• Performs other responsibilities as required.

Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.