Employment Type

Part time

Shift

Description:

RN Care Manager – Utilization Management

Location: Saint Francis Hospital

Department: Care Management / Utilization Review

Schedule: Per Diem | 1 Weekend per Month/Vacation Coverage | 8hr shift

Position Purpose

As a Case Manager in Utilization Management, you will be the key to ensuring patients receive appropriate, high-quality care. You’ll assess medical necessity, collaborate with healthcare teams and payers, and streamline care plans to align with clinical and regulatory standards. By optimizing resource utilization and maintaining the highest standards of care, you will contribute to a more efficient and patient-focused healthcare experience.

What You Will Do

• Evaluate and determine clinical appropriateness of inpatient admissions and observation status in compliance with payer requirements, clinical guidelines, and organizational protocols. Communicate findings with physicians to ensure alignment with medical necessity standards.
• Work closely with physicians, nurses, and the admissions team to coordinate care and address clinical documentation needs for accurate case review and status determination.
• Oversee the continuity of care by developing comprehensive care plans, ensuring seamless transitions between levels of care, and optimizing discharge planning to prevent re-hospitalizations.
• Monitor and manage the utilization of clinical resources to ensure efficiency and cost-effectiveness while maintaining high-quality patient outcomes.
• Provide guidance to clinical teams on proper documentation practices to support reimbursement and compliance with regulatory requirements.
• Educate patients and families on care options, disease management, and anticipated outcomes, serving as a resource for navigating post-acute care services.
  
  

Minimum Qualifications

• Licensure: Current Delaware RN license or eligibility for licensure.
• Experience:
• Minimum 1 year of experience as an RN Case Manager in an acute care setting with a focus on Utilization Review.
• Education: BSN preferred.
• Certifications: Willingness to obtain Case Management Certification (e.g., CCM or ACM) within one year of hire.
• Knowledge:
• Proficiency in MCG and/or InterQual criteria.
• Familiarity with CMS regulations, including the Two-Midnight Rule and Observation vs. Inpatient criteria.
  

Position Highlights

• Join a collaborative and mission-driven care management team.
• Opportunity to make a meaningful impact on patient outcomes and hospital performance.
• Supportive environment for professional growth and certification.
• Competitive compensation and comprehensive benefits package.
  
  

Ministry/Facility Information: 

Trinity Health Mid-Atlantic was formed in October 2018 and is the largest Catholic healthcare system serving the Greater Philadelphia area and is a part of Trinity Health of Livonia, Michigan, and sponsored by Catholic Health Ministries.

The hospitals and associated clinics, medical offices, specialized facilities, affiliated institutions and foundation represent more than 6,000 colleagues. These hospitals serve together in the spirit of the Gospel as a compassionate and transforming healing presence within their communities.

For more than 90 years, Saint Francis Hospital has served the Wilmington community and Northern New Castle County by providing compassionate health care of the highest quality. Founded by the Sisters of Saint Francis of Philadelphia in 1924, Saint Francis heeds a particular call to serve those in need. Our ministry is to serve all who require expert medical care regardless of religion, race, color, creed or economic status.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.