Case Management Specialist

6 days ago


Fulton, New York, United States UNC Health Care Full time
Job Overview

At UNC Health Care, we are seeking a skilled Case Management Specialist to join our team. This role is responsible for facilitating effective and cost-efficient care of patients through case management functions such as utilization review and discharge planning.

Key Responsibilities
  1. Access cases to determine the most effective and cost-efficient model for care, reviewing assigned patients' cases prior to or upon admission to recommend eligibility for pathways, protocols, or guidelines that could improve patient care and utilization of resources.
  2. Perform concurrent and retrospective admission and continued stay reviews for private insurance companies, Medicare, and Medicaid, in accordance with utilization review guidelines, informing the Manager of physicians' impact days and offering more cost-effective alternative approaches and/or recommendations to minimize reoccurrences.
  3. Determine the frequency of patient reassessments according to identified needs and input from RN and MD, serving as a resource person for nursing staff related to psychosocial, mental health, and substance abuse patient care, participating in the interdisciplinary plan of care, and collaborating with the nursing staff regarding patient/family education and discharge planning needs.
  4. Identify and report problematic DRGs, extended stay patients, frequent readmissions, or high-risk patients, identifying and reporting savings incurred through early discharges, identifying and reporting losses incurred due to extended stay and admission denials, and differentiating and reporting internal, external, patient/family origin for delayed discharges.
  5. Effectively serve as a patient/family resource and advocate, ensuring that their questions, concerns, and needs are addressed appropriately and in a timely manner, effectively coordinating and documenting the placement of patients into residential or rehabilitative settings, as needed, ensuring that administrative requirements are accurately and completely accomplished in accordance with procedure and time frames.

Education Requirements: Graduation from an accredited bachelor's in nursing program, licensed professional counselor (LPC), licensed certified addiction specialist (LCAS). Professional Experience Requirements: 2 years' experience in healthcare/medical field as registered nurse, 5 years of experience in healthcare/medical - counselor in crisis counseling, mental health counseling, or mental health nursing.



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