RN Case Manager - Case Management (Casual)

About the Organization

Licking Memorial Health Systems (LMHS) is a leading, non-profit healthcare organization passionately dedicated to improving the health and well-being of our community. With a history dating back to 1898, LMHS remains a cornerstone of healthcare excellence, catering to the evolving needs of Licking County. Our cutting-edge facility provides a comprehensive spectrum of patient care services, from life-saving emergency medicine to home healthcare, with specialized medical services including cancer, heart health, maternity, and mental wellness.

When you join the LMHS team, you become a vital part of your local community hospital. Working at LMHS offers a unique opportunity to directly impact the health and well-being of your friends, family, and neighbors. Our commitment to diversity, equity, and inclusion ensures every member of our community is served with respect and compassion. We are dedicated to patient safety, state-of-the-art technology, and a passionate team of highly trained and compassionate individuals striving to improve community health.

About the Role

The case manager is responsible for the comprehensive coordination of patient care and services across the continuum of care to promote high-quality, cost-effective, patient-centered outcomes. This role integrates clinical case management, utilization management, discharge planning, psychosocial assessment, counseling, and advocacy services for patients ranging from newborn through geriatric populations.

The Case Manager collaborates with patients, families, physicians, interdisciplinary team members, payers, and community agencies to address medical, psychosocial, and resource needs; facilitate appropriate utilization of healthcare services; support informed healthcare decision-making; and ensure safe, timely transitions of care.

Responsibilities

• Determines appropriate level of care on admission using hospital-approved medical necessity criteria.
• Performs patient and caregiver assessments to identify pertinent problems/needs.
• Organizes assessment data into an individual plan of care, with anticipated outcomes.
• Determines continued stay status.
• Participates in multidisciplinary rounds.
• Participates in patient education.
• Tracks and manages potential avoidable hospital days.
• Provides clinical information to external providers and managed care organizations.
• Assists in discharge planning.
• Assists in appeals and denials management.
• Conducts comprehensive clinical and psychosocial assessments of patients and caregivers to identify medical, emotional, social, financial, and discharge planning needs.
• Identifies barriers to care, facilitates problem-solving, and connects patients and families with appropriate community resources.

Requirements

• Graduate of an accredited school of nursing and licensed in the state of Ohio.
• 2 years of clinical experience in an acute care setting.
• Critical care/emergency department experience highly desired.
• Knowledge of evidence-based practice and disease management protocols.
• Utilization review and/or discharge planning experience preferred.
• Excellent verbal and written communication skills.
• Excellent computer skills.

LMH is accredited by DNV and TJC, and as such, may require specific annual education related to specialty certifications and standards.