RN Case Manager - Women's Specialty Care, Nursery, NICU

Responsibilities

• Captures and coordinates case management process from patient entry to post-discharge, including outpatient settings.
• Collaborates with physicians, social workers, and other team members to achieve optimal patient outcomes.
• Identifies patients suitable for case management intervention based on criteria such as cost, case complexity, and patient/family/provider request.
• Maintains and documents quality of care to ensure patient care plan goals are appropriate and implemented.
• Routinely assesses client and family responses to services, measures care plan effectiveness, and addresses identified needs.
• Assesses and discusses funding and insurance issues with clients, families, and healthcare providers to enhance cost-effective utilization of services and quality outcomes.
• Negotiates with third-party payers regarding benefit levels, eligibility, utilization reviews, and reimbursement.
• Identifies and addresses actual and potential delays in service requests or treatment, communicating them to the healthcare team to eliminate or minimize delays.
• Plans and oversees appropriate and timely discharges, establishes measurable discharge planning and self-management goals, and promotes safe, cost-effective, high-quality outcomes.
• Supervises technical support staff assigned to individual case management teams.
• May set up patients' follow-up appointments and perform post-discharge phone calls to patients according to care team design.
• May be required to conduct home or site visits as needed by the department.
• Works rotating schedules, including nights, weekends, and holidays, to meet the staffing and patient care demands of a 24/7 complex health system.

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, Occupational Therapist in the State of Utah, Physical Therapist in the State of Utah, Clinical Mental Health Counselor in the State of Utah, or Licensed Clinical Social Worker in the State of Utah.
• Basic Life Support Health Care Provider card through American Heart Association.
• Certified Case Management designation.
• Previous experience in clinical resource management activities and third-party payer interactions.