Case Manager ( RN / RT / SW / LPN )

About the role

We are 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. Our team plays a central role in providing compassionate, excellent care every step of the way.

Responsibilities

• Conduct utilization reviews and resource management.
• 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 via focus on resource management within the plan of care.
• Demonstrate compliance with facility-wide Utilization Management policies and procedures.
• Coordinate UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
• Maintain fiscal responsibilities, including identifying and negotiating the fullest possible reimbursement to maximize insurance benefit coverage for the patient.
• Review insurance verification forms to minimize risk.
• Facilitate multi-disciplinary team meetings including physicians, nurses, respiratory therapists, and rehabilitation therapists.
• Provide social work services, as necessary, per state guidelines.
• Complete medical record documentation.

Requirements

• Current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT), or Medical 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).

Preferred Qualifications

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

Schedule

Full Time: Monday–Friday, 8:00 AM–5:00 PM