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.

We are looking for valued employees who will be Champions of the Select Medical Way, which includes putting the patient first, helping to improve quality of life for the community in which you live and work, continuing to develop and explore new ideas, providing high-quality care and doing well by doing what is right.

Responsibilities

• Performs utilization reviews and resource management.
• Conducts discharge planning, treatment plan management and financial management.
• Completes medical record documentation.
• Reports directly to the Director of Case Management and provides social work services, as necessary, per state guidelines.
• 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 and promotes 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 and 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 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.

Preferred Qualifications

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

Shift

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