Case Manager / PRN ( RN / RT / SW / LPN )

About the Role

Our hospital is a critical illness recovery hospital committed to providing world‑class inpatient post‑ICU services to chronic, critically ill patients who require extended healing and recovery. We help patients during some of the most vulnerable, painful moments of their lives, and our team plays a central role in providing compassionate, excellent care every step of the way. The Case Manager reports directly to the Director of Case Management and, as needed, provides social work services per state guidelines.

Responsibilities

• Develop and implement a patient‑specific, safe, and timely discharge plan.
• Perform verification of utilization criteria reviews.
• Build relationships and coordinate with payor sources to assure proper reimbursement for hospital‑provided services and promote cost‑attentive care through resource management.
• Demonstrate compliance with facility‑wide Utilization Management policies and procedures.
• Coordinate utilization review compliance with Quality Management to meet licensure and accrediting requirements.
• Maintain fiscal responsibilities and negotiate maximum insurance benefit coverage for patients.
• Review insurance verification forms to minimize risk.
• Facilitate multidisciplinary team meetings including physicians, nurses, respiratory therapists, and rehabilitation therapists.
• Complete medical record documentation.

Requirements

• Current licensure in a clinical discipline: Nurse (RN/LPN/LVN), Respiratory Therapist, or certified Social Work license (SW/MSW) per state guidelines.
• Previous experience as RN/LPN/RT/SW/CM in an inpatient hospital setting caring for critical/acute care patients (e.g., ICU, step‑down, med‑surg, ventilated patients).
• Adequate experience in an acute medical case‑management setting with confidence to manage and direct a plan of care for chronically critically ill populations.

Preferred Qualifications

• Specific experience in Care Management and Discharge Planning.
• Working knowledge of the insurance industry and government reimbursement processes.

Schedule

Availability to work a minimum of 2 shifts per month on an “as needed” basis. Shifts are scheduled on weekdays, approximately 8 a.m. – 5 p.m.