RN Case Manager - Weekend - Case Management

About the Role

The Case Manager oversees the process of care delivered to patients, works collaboratively, and provides leadership to the healthcare team while being committed to organization goals. This role examines records for medical treatments and interventions to avoid payment denial and optimize reimbursement by assessing appropriateness of treatments, effectiveness, timing, and setting. This includes determining observation level of care vs inpatient level of care based on medical necessity and patient assessment for discharge planning.

Responsibilities

• Integral in minimizing and assisting with barriers to discharge.
• Coordinates and facilitates patient care progression throughout the continuum of care.
• Ensures the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective.
• Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with the physician.
• Monitors length of stay and ancillary resource use on an ongoing basis and takes actions to achieve continuous improvement in both areas.
• Communicates information to the Utilization Management or Case Management team to aid in appropriate level of care determination and reimbursement by third-party payors.
• Works closely with the Physician Advisory team on concurrent denials to ensure the most appropriate level of care prior to billing.
• Monitors patient flow through multidisciplinary rounds and aids in the implementation of processes for improvement to decrease delays.
• Serves as a patient advocate to the ED population by identifying needs, coordinating services, and resources for the management of complex patients to facilitate quality care and cost-efficient outcomes.
• Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team.
• Ability to cover various populations across the organization, including the Emergency Department.
• Performs all other duties as requested by the Case Manager Supervisor and/or Director.

Requirements

• 1-2 years of recent acute care hospital experience required.
• Data entry/computer experience required.

Qualifications

• Licenses and Certifications: Registered Nurse

About Us

Founded in 1906, McLeod Health is a locally owned and managed, not-for-profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice, and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health.

The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon, and McLeod Behavioral Health.

About The Team

If you would enjoy working in a dynamic environment and are looking for an opportunity to become part of a stellar team of professionals, we invite you to apply.