Case Manager RN - Utilization Management

Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community! Lower Bucks Hospital, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.

Lower Bucks Hospital is a community hospital, serving the Lower Bucks County region with medical, surgical, and emergency care. Located in historic Bristol, Pennsylvania, the Hospital is well-known for its knowledgeable medical staff, including cardiology, orthopedics, radiology, wound care, and general surgery. The hospital has more than 200 physicians on staff, as well as another 700 employees.

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and ensure the achievement of quality, clinical and cost-effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

• Minimum 5 years' work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license

• At least one year experience in case management, discharge planning or nursing management

• Experience and knowledge in basic to intermediate computer skills.

• Five years of acute care nursing experience. preferred

• CCM or obtained within 1year

• Knowledge of Milliman Criteria and InterQual Criteria preferred.

• Current BCLS certificate, preferred

Employment Status: Per Diem Shift: Variable Equal Employment Opportunity:

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf