Clinical Case Manager for Patient Care and Discharge Planning

3 days ago


Bristol, Connecticut, United States BRISTOL HOSPITAL GROUP Full time

Bristol Hospital Group seeks a skilled Clinical Case Manager to join our team in Bristol, CT.

About the Role

We are committed to providing compassionate, quality care at all times and upholding our values of Communication, Accountability, Respect, and Empathy (C.A.R.E.). As a Clinical Case Manager, you will play a crucial role in ensuring seamless patient transitions and delivering effective care coordination services.

Responsibilities
  • Determine medical necessity, appropriateness of admission, continuing stay, and level of care using a combination of clinical information, clinical criteria, and third-party information.
  • Validate admission and continuing stay criteria with third-party payers, including onsite and telephonic Case Managers, as well as Primary Care and Attending Physicians.
  • Collaborate with third-party payers to anticipate denial of payment and proactively address issues contributing to potential denials.
  • Support the effective prevention and management of denials, including drafting appeal letters and/or providing information as part of the appeal process.
Requirements
  • Minimum of 5 years of broad clinical experience, predominately in medical/surgical nursing.
  • Case Management, discharge planning, and utilization review experience preferred.
  • Licensed as a Registered Nurse in the state (or eligible for licensure).
  • BSN preferred or actively working towards BSN.
Compensation

The estimated annual salary for this position is $ 90,000 - $120,000, depending on experience and qualifications. Additionally, we offer a comprehensive benefits package, including health insurance, retirement plan, and paid time off.

Why Join Us?

Bristol Hospital Group is a Magnet hospital and has received the 2020 Press Ganey Leading Innovator award for our rapid adoption and implementation of healthcare solutions during the COVID-19 pandemic. We value our employees' expertise, compassion, and kindness and strive to create a work environment that promotes growth, learning, and success.



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