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.

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.
• Collaborates with 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.

Skills

• Compassion
• Excellent communication skills
• Strong organizational and time management skills
• Ability to work independently and as part of a team

Benefits

Our hospital offers a comprehensive benefits package including health insurance, retirement plans, and paid time off.

Pay

Compensation is commensurate with experience.

Schedule

Shifts would be scheduled on weekdays, from approximately 8a.m.-5p.m.