RN Case Manager - Inpatient U of U Hospital

Responsibilities

• Coordinates case management process from patient's entry into the healthcare system to post-discharge, including outpatient settings.
• Carefully coordinates care and resources with physicians, social workers, and other team members to achieve optimal patient outcomes.
• Identifies patients who are suitable for case management intervention based on criteria such as cost, case complexity, frequency of admission or patient/family/provider or other healthcare team member request.
• Makes sure quality of care is appropriate and documented, and that patients and families understand and implement care plans.
• Assesses and addresses patient and family needs, including ethical and cultural considerations.
• Works to achieve cost-effective outcomes by determining appropriate levels of care based on diagnoses, severities, and other relevant criteria.
• Collaborates with third-party payers to resolve issues related to benefits, eligibility, utilization reviews, and reimbursements.
• Communicates delays in service requests or treatments to the healthcare team to prevent or minimize delays.
• Plans and implements appropriate and timely discharges, setting measurable discharge planning and self-management goals.
• Supervises technical support staff and may set up follow-up appointments and make post-discharge phone calls.
• Performs home or site visits as needed by the department.

Qualifications

• Two years of professional experience in a clinically related area.
• Dependent upon the department of hire, may be required to provide reliable transportation for site visits.
• One of the following licenses: Registered Nurse in the State of Utah, Licensed Clinical Social Worker (L.C.S.W.), Clinical Mental Health Counselor in the State of Utah, Physical Therapist in the State of Utah, or Occupational Therapist in the State of Utah.
• Basic Life Support Health Care Provider card through American Heart Association.
• A Certified Case Management designation.
• Previous experience in clinical resource management activities and third party payer interactions.