About the Organization
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.
The case manager is responsible to assist in the development, planning, cordination and administration of the activities of utilization review. Conduct initial and concurrent review of the medical record to determine appropriateness and medical necessity of admission, continued hospital stay and use of ancillary services. Assumes a leadership role within the interdisciplinary team to coordinate services trough the continuum of care to achieve optimal clinical and resource outcomes.
Interviews patients and families to assess for discharge needs.
Screens for high risk patients and manages to that.
Performs utilization function in accordance with InterQual standards, medicare regulations and payer contracts. This includes admission and concurrent reviews, seeking authorizations from payers as appropriate and referring cases to the Physician Advisor.
Communicates determinations to all stakeholders.
Argues denials assertively.
completes peer to peer paperwork for the Pysician Advisor.
Utilizes Case Management software to document UM process as well as dischare proc ess.
Tracks avoidable days.
Identifies barriers to treatment and can initiate a plan that supports optimal quality, cost and patient satisfaction.
Current RN License in the state of PA
RN from an accredited school of nursing
Associate degree or Bachelor's Degree
Cerfitied Case Manager preferred.
3 years Case Management experience required
5 years RN experience preferred.