- Bachelor’s degree or graduate from an accredited school of Nursing.
- Current Pennsylvania RN license.
- 3-5 years of nursing experience in an acute care setting, with 3+ years of case management, discharge planning, or homecare experience preferred;
- 2 + years of prior experience with Utilization Management
Knowledge, Skills & Abilities
- Excellent relationship management skills, including a high degree of psychological sophistication and non-aggressive assertiveness.
- Ability to problem solve complex, multifaceted and emotionally charged situations.
- Ability to make sound, independent judgments and act professionally under pressure.
- Ability to effectively communicate and collaborate with physicians and other providers, patients, families, and ancillary staff.
- Requires superior interpersonal skills; especially important will be the ability to engage and motivate patients, physicians, and service providers telephonically.
- Knowledge of current “best practice” standards of patient care.
- Thorough understanding of, and compliance with, RN scope of practice in the Commonwealth of Pennsylvania.
- Excellent communication skills; ability to represent the organization to internal and external stakeholders with skill and confidence.
- Organized, detailed, and proactive; responds to requests in a timely and efficient manner.
- Collaborative and resourceful; functions successfully in a team environment as well as independently.
- Computer literate with proficiency in Microsoft Office suite of programs.
- Ability to type 45 wpm.
- Knowledge of medical terminology, CPT and ICD coding.
- Knowledge of IPA/group internal processes and contractual agreements.
- Working knowledge of HMO/managed care/health plans.