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.

As a Case Manager, you will be 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.
• Builds relationships and coordinates with payor sources to assure proper reimbursement for hospital-provided services, promote cost-attentive care via focus on resource management within the plan of care.
• Demonstrates compliance with facility-wide Utilization Management policies and procedures.
• Coordinates UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
• Maintains fiscal responsibilities, ensuring the department identifies and negotiates 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 (SW/MSW) per state guidelines.
• Previous RN/LPN/RT/SW/CM experience in an inpatient hospital setting dealing with critical care/acute care patients (e.g., 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.
• Availability to work a minimum of 2 shifts per month on an "as needed" basis—shifts would be scheduled on weekdays, from approximately 8 a.m.–5 p.m.

Preferred Qualifications

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

Pay

$48 per hour

Schedule

PRN (as needed), with a minimum of 2 shifts per month on weekdays, approximately 8 a.m.–5 p.m.