Case Manager
4 weeks ago
The Case Manager will coordinate, negotiate, and manage the care of complex patients to facilitate quality and cost-effective patient outcomes. This role requires collaboration with interdisciplinary staff, internal and external to the organization, to ensure seamless patient care. The Case Manager will participate in quality improvement and evaluation processes, review patients for utilization management, and develop discharge plans. The ideal candidate will have a strong clinical background, excellent communication skills, and the ability to work effectively in a fast-paced environment.
Key Responsibilities
• Determine medical necessity and appropriateness of admission and stay in accordance with Interqual guidelines.
• Prepare Medicare/Non-Medicare hospital notices of noncoverage (HINN) when patient's level of care is no longer covered according to the guidelines.
• Identify patients for Case Management services and maintain a working knowledge of third-party payer requirements.
• Communicate and collaborate with physicians, team members, patients, payers, and administrators to assess needs and provide a plan of care.
• Formulate, implement, and evaluate plans to address assessed needs and issues, and revise plans as needed to reflect changing needs and goals.
• Evaluate the effects of Case Management on target populations and explore strategies to reduce length of stay and resource consumption.
Requirements
• Graduate of an approved registered nursing program with a current license as a registered nurse. BSN or Case Management Certification preferred.
• Three years of clinical nursing experience in an acute care hospital setting or two years of utilization management experience in an acute care hospital setting. Case management experience preferred but not required.
• Basic Life Support (BLS) preferred.
Working Conditions
This role requires light physical effort and routine office work. The employee will be exposed to Category I tasks involving exposure to blood, body fluids, or tissues.
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