Case Manager - Care Coordination - Days - FT

Memorial Hospital at Gulfport•Gulfport, MS

About The Position

The Case Manager coordinates the efforts of patients, families, and healthcare professionals to develop a plan of care across the continuum based on identified needs. The role reviews and assesses the appropriateness of patient admissions and continued stays in accordance with established policies and procedures. The Case Manager ensures delivery of coordinated, quality, and cost-effective care through collaboration with patients, families, healthcare providers, staff, payers, and a multidisciplinary team. The role also supports discharge planning, utilization review, communication, and the collection and tracking of information for quality and safety functions.

Requirements

Associate's degree or bachelor's degree.
Graduate of an accredited nursing program; Bachelor of Science in Nursing (BSN) listed.
3 years of clinical experience as a registered nurse in an acute care facility.
Advanced knowledge of quality management, utilization management, case management, and/or DRG documentation compliance principles.
Excellent customer service and communication skills.
Strong organizational and problem-solving skills.
Advanced statistical and spreadsheet/database application skills.

Responsibilities

Ensures implementation of the prescribed plan of care in collaboration with the patient, family, and healthcare providers.
Coordinates care and services across the continuum, working directly with the patient and family, healthcare providers, staff, and payers.
Evaluates and communicates patient progress toward established outcomes.
Coordinates multidisciplinary discharge planning to assess current and discharge needs.
Evaluates patient satisfaction and the quality of care provided.
Provides post-discharge follow-up to ensure progress of the discharge plan.
Promotes quality and cost-effective interventions, resources, and outcomes using a multidisciplinary team approach.
Reviews and determines the necessity and appropriateness of hospitalization using established criteria to prevent payment denials.
Refers appropriate cases to the physician advisor for intervention.
Serves as a liaison with healthcare providers, admissions, and medical records staff to support continuity of patient care, discharge planning, and effective communication.
Arranges appropriate referrals for counseling, financial assistance, and discharge planning assistance as needed.
Assists with the collection, delivery, and tracking of information for Performance Improvement, Risk Management, and Infection Control.