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

About the role

The Case Manager is responsible for utilization reviews and resource management, discharge planning, treatment plan management and financial management, while also completing medical record documentation. You will report directly to the Director of Case Management and provide social work services, as necessary, per state guidelines.

Responsibilities

• Develops and implements a patient specific, safe and timely discharge plan.
• Performs verification of utilization criteria reviews.
• Buils relationships and coordinate with payor sources to assure proper reimbursement for hospital provided services, promote costs attentive care via focus on resource management within the plan of care.
• Demonstrates compliance with facility-wide Utilization Management policies and procedures.
• Cohorts UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
• Maintains fiscal responsibilities. Assures the department is identifying and negotiating the fullest possible reimbursement to maximize insurance benefit coverage for the patient.
• Reviews insurance verification forms to minimize risk.
• Facilitates multi-disciplinary team meetings including physicians, nurses, respiratory therapists and rehabilitation therapists.

Requirements

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

Qualifications

• Working knowledge of the insurance industry and government reimbursement.
• Availability to work a minimum of 2 shifts per month on an "as needed" basis - shifts would be scheduled on weekdays, from approximately 8a.m.-5p.m.