Case Manager, Utilization Review (Per-Diem)

Purpose & Scope

The Case Manager is responsible for the collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes. Additionally, the Case Manager ensures that identified and referred patients have a coordinated continuum of care in accordance with JCAHO and hospital guidelines and serves as liaison for the interdisciplinary team, the patient, and family to ensure a timely, smooth, and clinically appropriate care planning process. The Case Manager also maintains communications with the payor at the time of admission and throughout the hospitalization to ensure necessary approvals for care and clarification of benefits. They facilitate retrospective reviews and approvals for care whenever necessary, and they implement and coordinate discharge plans utilizing available and appropriate community resources.

Education

Graduation from an accredited school of social work, nursing, in a related field or equivalent is required.

Experience

• Five years of experience in the healthcare field is preferred.
• Experience in case management is preferred.

Certification/Licensure

None.

Benefits

At VHC Health, every role contributes to exceptional care, better outcomes, and stronger communities. In addition to your base compensation, VHC Health offers a comprehensive benefits package, including medical, dental, and vision coverage (subject to eligibility requirements), as well as additional wellness and retirement benefits designed to support our employees and their families.