Case Manager II

Job Summary

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions

• Care Coordination
• Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Maintains current knowledge regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
• Appropriately refers high-risk patients who would benefit from additional support.
• Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions.
• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs.
• Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients’ care throughout the care continuum.
• Discharge Planning
• Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning.
• Provides comprehensive discharge planning for each patient. Utilizes critical thinking to develop and execute effective discharge planning.
• Coordinates and communicates with patient/family efficiently and effectively.
• Utilization Management
• Conducts medical necessity review for appropriate utilization of services from admission through discharge.
• Promotes effective and efficient utilization of clinical resources.
• Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.
• Other
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Serves on Hospital and Division committees when requested.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Ability to demonstrate critical thinking, appropriate prioritization and time management skills.
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers.
• Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.

Pay Range

$51.19 - $64.92/Hr

Benefits

ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness.

Education

Graduate of an accredited program required for RN. BSN preferred or MSW/BSW with licensure as required by state regulations.

Licenses/Certifications

Healthcare professional licensure required as Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations. Certification in Case Management a plus.

Experience

Two years of experience in a healthcare setting preferred. Prefer prior experience in case management, utilization review, or discharge planning.