Case Manager ( RN / RT / SW / LPN )

Select Medical • Macon, GA

1d

About The Position

Select Specialty Hospital is a critical illness recovery hospital (LTACH) providing inpatient post-ICU services to chronically ill patients who need extended healing and recovery. The Case Manager supports patients through this recovery by coordinating utilization review, resource management, discharge planning, treatment plan management, and financial management, while completing medical record documentation. The role also provides social work services as necessary, in accordance with state guidelines.

The Case Manager develops and implements safe, timely, patient-specific discharge plans; verifies utilization criteria; and coordinates with payors to support appropriate reimbursement and cost-conscious care. The position works with Quality Management to ensure utilization review compliance with facility policies and licensing and accreditation requirements. It also supports fiscal responsibilities and reimbursement negotiations, reviews insurance verification forms, and facilitates multidisciplinary team meetings involving physicians, nurses, respiratory therapists, and rehabilitation therapists.

This is a full-time, Monday-through-Friday position with hours of 8:00 a.m. to 5:00 p.m. Salary is based on relevant prior experience and is listed as $70,000–$95,000. The position reports directly to the Director of Case Management.

Requirements

• Current licensure in a clinical discipline as a nurse (RN/LPN/LVN) or respiratory therapist (RT), or a current social work license or certification as required by state guidelines.
• Previous RN/LPN/RT/SW/CM experience in an inpatient hospital setting caring for critical-care or acute-care patients, such as ICU, step-down, medical-surgical, or ventilator patients.

Nice To Haves

• RN licensure is preferred.
• Experience in care management and discharge planning.
• Working knowledge of the insurance industry and government reimbursement.

Responsibilities

• Conduct utilization reviews and manage resources, discharge planning, treatment plans, and financial matters.
• Complete medical record documentation.
• Provide social work services as necessary, consistent with state guidelines.
• Develop and implement safe, timely, patient-specific discharge plans.
• Verify utilization criteria.
• Coordinate with payor sources to support proper reimbursement and cost-conscious care through resource management.
• Comply with facility-wide Utilization Management policies and procedures.
• Coordinate utilization review compliance with Quality Management to meet licensing and accreditation requirements.
• Maintain fiscal responsibilities.
• Identify and negotiate the fullest possible reimbursement to maximize patients’ insurance benefit coverage.
• Review insurance verification forms to minimize risk.
• Facilitate multidisciplinary team meetings with physicians, nurses, respiratory therapists, and rehabilitation therapists.

Benefits

• Extensive orientation program.
• Generous paid time off and paid sick time for full-time team members.
• Medical/RX, health, vision, employee assistance program (EAP), and dental plan offerings for full-time team members.
• Company-matching 401(k) retirement plan.
• Life and disability protection for full-time team members.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed