PRN Case Manager II

About the Role

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery, and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation, and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, promotes continuity of care, and cost effectiveness through the integration of case management, utilization review and management, and discharge planning.

Responsibilities

• Care Coordination
  • Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
  • Monitors all areas of patients’ stay for effective care coordination and efficient care facilitation.
  • Remains current on reimbursement modalities, community resources, case management, psychosocial, and legal issues affecting patients and providers.
  • Appropriately refers high-risk patients who would benefit from additional support.
  • Serves as a patient advocate and enhances collaborative relationships to support informed decision-making by patients and families.
  • Demonstrates knowledge of growth and development principles across the lifespan to provide age-appropriate care.
  • Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, and address post-hospital needs.
  • Collaborates with clinical staff in developing and executing the plan of care and achieving goals.
  • Coordinates with the interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others throughout the care continuum.
• Discharge Planning
  • Conducts comprehensive, ongoing assessments to provide timely and safe discharge planning.
  • Develops and executes effective discharge plans for each patient using critical thinking.
  • Coordinates and communicates efficiently with patients and families regarding discharge plans.
• Utilization Management
  • Conducts medical necessity reviews for appropriate utilization of services from admission through discharge.
  • Promotes effective and efficient utilization of clinical resources.
  • Conducts timely and accurate clinical reviews, care collaboration, and coordination of continued stay authorization with payors.
• Other
  • Adheres to the Company’s Code of Business Conduct, policies, procedures, and applicable professional standards.
  • Serves on Hospital and Division committees when requested.
  • Performs other related duties as assigned.

Requirements

• Postsecondary (Cert/Diploma/Program Grad) from an accredited school of nursing (Required).
• Bachelor’s Degree in nursing or social work: BSN, MSN, BSW, or MSW (Preferred).
• Licenses/Certifications:
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure in the state of practice (Required), or
  • LCSW - License Clinical Social Worker (LCSW or LSW) (Required).
  • CSWCM - Social Work Case Manager Certification (Preferred).
• 2+ years of experience in a healthcare setting (Required).
• Prior experience in case management, utilization review, or discharge planning (Preferred).

Skills

• Knowledge of government and non-government payor practices, regulations, standards, and reimbursement.
• Knowledge of Medicare benefits, insurance processes, and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Critical thinking, prioritization, and time management skills.
• Basic computer skills with proficiency in Microsoft Office, word-processing, and spreadsheet software.
• Excellent interpersonal, verbal, and written communication skills.
• Ability to collaborate effectively with hospital leadership, physicians, payors, and external customers.
• Strong interpersonal skills for interacting with patients, families, and staff.
• Must read, write, and speak fluent English.
• Good and regular attendance.