Case Manager II NE

Kindred Healthcare•Dayton, OH

10d

About The Position

Coordinates and facilitates care for patients through collaboration and communication with Interdisciplinary Care Transitions (ICT) team members. Follows patients across the continuum of care and supports appropriate resource utilization, service delivery, and compliance with external review agencies. Provides ongoing expertise through comprehensive assessment, care planning, plan implementation, and evaluation of individual patient needs. Integrates case management, utilization review and management, and discharge planning to improve patient management and satisfaction, continuity of care, and cost effectiveness. The role includes coordinating care with interdisciplinary teams, physicians, patients, families, post-acute providers, payors, and other partners; advocating for patients; supporting informed decisions; and planning safe, timely discharges. It also conducts medical-necessity reviews, facilitates continued-stay authorizations, and promotes efficient use of clinical resources. The Case Manager performs work in accordance with company policies and applicable laws and professional standards, and may serve on hospital or division committees when requested.

Requirements

At least 2 years of experience in a healthcare setting.
Postsecondary certificate, diploma, or program graduation from an accredited school of nursing.
RN state or compact-state licensure in the state of practice upon hire, or LCSW/LSW licensure upon hire.
Knowledge of government and non-government payor practices, regulations, standards, and reimbursement.
Knowledge of Medicare benefits, insurance processes, and contracts.
Knowledge of accreditation standards and compliance requirements.
Critical-thinking, prioritization, and time-management skills.
Basic computer skills and working knowledge of Microsoft Office, word-processing, and spreadsheet software.
Excellent interpersonal, verbal, and written communication skills to obtain cooperation and collaboration from hospital leadership, physicians, payors, and other external customers.
Good interpersonal skills when interacting with patients, families, and staff.
Fluent English reading, writing, and speaking ability.
Good and regular attendance.

Nice To Haves

Bachelor’s degree in nursing or social work (BSN, MSN, BSW, or MSW).
Prior experience in case management, utilization review, or discharge planning.
Social Work Case Manager Certification (CSWCM) upon hire.

Responsibilities

Coordinate clinical and psychosocial activities with the interdisciplinary team and physicians.
Monitor patients’ stays to support effective care coordination and efficient care facilitation.
Maintain current knowledge of reimbursement modalities, community resources, case management, and psychosocial and legal issues affecting patients and providers.
Refer high-risk patients who may benefit from additional support.
Serve as a patient advocate and support patients and families in making informed decisions.
Apply knowledge of growth and development across the lifespan to provide age-appropriate care to the patient population served.
Participate in interdisciplinary patient care rounds or conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs.
Collaborate with clinical staff to develop and execute plans of care and achieve goals.
Coordinate patient care throughout the continuum with the interdisciplinary team, physicians, patients, families, post-acute providers, payors, and others.
Conduct comprehensive, ongoing patient assessments to support timely and safe discharge planning.
Provide comprehensive discharge planning for each patient and use critical thinking to develop and execute effective plans.
Communicate and coordinate effectively with patients and families.
Conduct medical-necessity reviews for appropriate utilization of services from admission through discharge.
Promote effective and efficient utilization of clinical resources.
Conduct timely and accurate clinical reviews and coordinate continued-stay authorization with payors.
Perform duties in accordance with the Company’s Code of Business Conduct, policies and procedures, Corporate Compliance Agreement, applicable laws, and professional standards.
Serve on Hospital and Division committees when requested.
Perform other related duties as assigned.