Description
The Case Manager coordinates all authorizations and reauthorizations for patient services, identifies care needs for safe and appropriate discharge planning, ensures compliance with third-party payers, and acts as Utilization Review liaison with Health Information Management (HIM).
Requirements
Registered Nurse or a Social Worker
Master of Social Work or current WY RN license or a in social work
Two to three years' experience in hospital setting preferred
Experience with hospital, SNF, and health plan-based case management systems preferred
BLS required
Summary
Assist with the development, implementation, and ongoing evaluation of the Case Management System, including collaboration with clinical departments and community resources.
Direct, coordinate, and deliver case management for patients, including assessment of needs, planning interventions, monitoring effectiveness, and maintaining required documentation.
Participate in case finding, pre-admission evaluation, and screening for optimal reimbursement and proactive discharge planning.
Perform comprehensive case management assessments and prepare transition plans that optimize clinical and psychosocial outcomes, involving family and outside agencies as needed.
Supply clinical information to third-party payers to ensure continued reimbursement and timely authorizations.
Communicate and collaborate with the healthcare team to optimize resource utilization, anticipate barriers, and facilitate timely and appropriate discharge planning.
Identify, refer, and facilitate admissions to Transitional Care Center (TCC) and other appropriate referral organizations, monitoring criteria and readiness.
Prepare, update, and maintain records, reports, and written transfer/discharge plans, following all regulatory and institutional requirements.
Establish and maintain external relationships with referral sources, insurers, vendors, and external case managers, ensuring effective communication and care continuity.
Maintain a professional commitment, flexibility, and current knowledge of relevant guidelines, CEU credits, and resources for case management and discharge planning.
Assure department delivers high-quality services meeting regulatory standards and participating in quality improvement program reporting.
Achieve agreed-upon goals and objectives within prescribed timelines, supporting the hospitals overall mission.
Follows all exposure control plans for bloodborne/airborne pathogens and maintains compliance with protective barrier policies and annual education.
Promote effective working relationships, foster a supportive team environment, participate in meetings, and support the hospital’s mission and policies.
Behave and dress in a professional and courteous manner consistent with the facilities Standards of Behavior.
Perform other duties as assigned