Pottstown Hospital
Registered Nurse Utilization Review Case Manager- Per Diem
At a glance
Location: US-PA-Pottstown Map
Posted: 11/16/2019
Closing: 12/15/2019
Degree: 2 Year Degree
Type: Per Diem
Experience: Not Specified
Pottstown Hospital
Job description

Tower Health is a strong, regional, integrated healthcare provider/payer system that offers leading-edge, compassionate healthcare and wellness services to a population of 2.5 million people. Together, our six hospitals and other entities provide a full range of medical care from prevention, screenings & education; to the latest clinical services and surgeries available; to rehabilitation. We also offer wellness programs & public health services that ensure our communities are the healthiest they can be. Our caring, highly trained physicians and staff are committed to patient safety and patient satisfaction.


With more than 11,000 team members, Tower Health includes Reading Hospital, a teaching hospital based in West Reading; Brandywine Hospital in Coatesville; Chestnut Hill Hospital, a teaching hospital in Philadelphia; Jennersville Hospital in West Grove; Phoenixville Hospital in Phoenixville; and Pottstown Hospital in Pottstown. We also operate Reading Hospital Rehabilitation at Wyomissing & Reading Hospital School of Health Sciences, & we have a comprehensive physician network.

Collaboration across Tower Health enables our hospitals, providers, leadership & staff to leverage best practices across the health system. Our hospitals have received national recognition for advanced care in areas such as neurosurgery and stroke, cardiac & vascular surgery, trauma, hematology & oncology. Reading HealthPlex, which opened at Reading Hospital in October 2016, combines state-of-the-art technology and world-class design to make the HealthPlex one of the most sophisticated surgical centers & inpatient facilities in the region.

At Tower Health, we have a rich history of providing high-quality, cost-effective care in the communities we serve. As the healthcare industry continues to change, one thing remains steadfast: Tower Health’s commitment to Advancing Health, Transforming Lives



Responsibilities

The RN UR Case Manager provides oversight and coordinates day to day functions.

Responsibilities:

Supervises and monitors the coordination of Utilization Review/Denials Management for
designated patient populations.
Provides input to the Case Management Director regarding issues and obstacles to timely
utilization review. Assists in identifying and creating solutions to barriers that result in delays
in transition.
Acts as the primary resource to UR staff. Functions as a RN UR Case Manager as
necessary. Coordinates the team schedules to ensure adequate coverage.
Works closely with IT staff to ensure that the technical needs of the department are
being met and assists in coordinating technical activities as needed.
Demonstrates the ability to analyze, identify issues and problem-solve effectively. Takes
action on issues as appropriate to support successful outcomes.
Ensures payer and customer satisfaction by utilizing effective communication and
interpersonal skills. Notifies RN Case Manager and physician of all decisions to issue a notice
of non-coverage for all payers.
Tracks and trends UR data and outcomes as directed. Participates in performance
improvement initiatives and performs other UR related functions as directed. Documents
according to policy.

Educates members of the healthcare team about managed care principles, observation
status, discharge planning, reimbursement rules, and range of patient care settings and
acute hospital levels of care.

Demonstrates compliance with all local, state and federal regulations and requirements.
Assures adherence to TJC accreditation standards.
Completes statistical information according to departmental, state, federal and payer
guidelines and regulations.
Demonstrates compliance with documentation requirements as reflected through audits

#LI



Qualifications

EDUCATION REQUIREMENTS
• Graduate of an accredited school of Nursing
EXPERIENCE
• Relevant Experience
CERTIFICATION AND LICENSURE REQUIREMENTS
• PA Registered Nurse License
REQUIRED SKILLS
• Excellent Communications Skills
• Excellent Interpersonal Skills
• General Clerical Skills

Registered Nurse Utilization Review Case Manager- Per Diem