Case Manager - Rehabilitation

Lifepoint Health•Hickory, NC

7d•Onsite

About The Position

Manager of Case Management in the departments activities and resources to achieve departmental and organizational objectives and will take the lead in the absence of the Director. Accountable for the execution, adaptation, and outcome of care management as described in the initial UM plan with regard to resources, appropriateness of care and adherence to a designated GMLOS for each patient. Frye Regional Medical Center, located in the beautiful foothills of North Carolina is a 355-bed acute care hospital, 81-bed Behavioral Health facility and more than 70 primary and specialty care providers.

Requirements

Associates Degree in Nursing required
Current RN license to practice in NC (NC licensure or multi-state (compact) license).
Five years hospital- based clinical experience.
Experience in Case Management, Utilization Review and/or Discharge planning, knowledge of Interqual and other payor criteria required.
Must have excellent communication skills, demonstrate self-direction, and have the ability to work well in a team environment

Nice To Haves

Bachelor's Degree in Nursing preferred.

Responsibilities

Monitors the daily assignment and makes adjustments as needed to maintain an evenly distributed caseload for CM’, SW’s, and D/C Planners
Keeps staff up to date on their time in kronos; fixes missed punches
Takes messages off insurance line and communicates information to correct persons.
Completes Retro’s as needed and enters days authorized into Cerner for billing purposes.
Enters billing changes into Cerner so billing knows correct way to bill; ie direct admits or bill different than status
Researches medical records to assist if business office or coding department has questions; also assists revenue integrity with questions
Monitors all OBS patients to remain <24hrs
Follows discharges daily to make sure all days authorized for hospital stay.
Scribes for IDT Meeting daily and quarterly UM committee meetings
Performs monthly audits as designated by the DCM; MCL and Patient choice; also completes missed final dispositions paperwork.
Notifies DCM and business of denials and enters on a denial log.
Fights denials by not accepting if not appropriate and constantly sending updated information and asking for re-reviews.
Assist UR as needed with sending clinicals to insurances to keep information timely
Participates in the hiring of new employees, as well as managing current staff needs
Resource person for post-acute services.
In director absence attends morning huddle, morning throughput meetings regarding dc for the day.
Is involved if and when state comes on site.
Attendance Policy
Communications

Benefits

Wide range of benefits options!
Here at Frye, you choose your own Medical, Dental, and Vision plans from a variety of competitive options that give you the coverage that best fits your needs.
HSA
401(K) retirement plan contributions
Generous Paid Time Off
Accident & Critical Illness Insurance
Prescription Assistance with OptumRx
Income protection programs for the entire family such as life insurance, Short/Long-term Disability, and Identity Theft.
Employee Assistance program at no cost to you to provide emotional, legal, financial, and daily life support for your entire household.
Services are available 24 hrs. a day, 7 days a week.
Free travel and entertainment discount program to ensure you enjoy your time away from work.