The Purpose of the Portal of Entry Care Manager is to support the physician and the interdisciplinary team in facilitating patient care, with the underlying objective of documenting medical necessity in the initial utilization review, enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates utilization management, care facilitation and simple discharge planning functions. In addition, the Portal of Entry Care Manager helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction).

Graduate of an accredited School of Nursing. Associates Degree required, Bachelors preferred.

• Two years clinical experience as a Registered Nurse in a hospital
• One-year recent experience in Care Management

• Current Knowledge of reimbursement requirements, level of care criteria, SI/IS criteria, GMLOS knowledge, DRGs, InterQual guidelines required
• Case Management Certification, preferred