Case Manager Admissions – Lehigh Valley Health Network – Allentown, PA

Job Summary:

Ensures appropriate use of hospital resources by reviewing all patients admitted to the hospital and evaluating appropriateness of admission using approved criteria. Ensures appropriate patient class assignment (inpatient, outpatient) to ensure compliance with third party payer requirements.

Education – Required:

Specialized Diploma in nursing

Education – Preferred:

Bachelor’s Degree In nursing

Experience – Required:

2 years of previous utilization review experience. and
2 years Knowledge of utilization management as it relates to third party payers.

Experience – Preferred:

3 years of experience in acute care and
5 years of experience in case management and DC planning experience within the last 5 years.

Knowledge, Skills, and Abilities – Required:

Ability to maintain the strictest adherence to HIPAA while maintaining confidentiality of all PHI.
Ability to work in a team environment demonstrating flexibility to work toward common goals based around prioritized needs.
Ability to be attentive to detail and maintain a positive attitude.
Ability to complete work assignments accurately and in a timely manner while managing multiple responsibilities and prioritizing all tasks effectively.
Demonstrates proficiency with all work queue processes.
Knowledge of evidence-based clinical decision support criteria.

Knowledge, Skills, and Abilities – Preferred: