Case Manager (CM), Social Worker (LSW)

Lifepoint Health•Pasco, WA

About The Position

The Case Manager coordinates patient care planning, utilization review, and discharge planning at Lourdes Behavioral Health. The role facilitates weekly patient care team conferences to develop, monitor, and refine treatment plans; reviews assigned CMGs for potentially missed comorbid conditions being treated during the stay and communicates findings to the HIM team; and supports concurrent and retrospective utilization review, including denials and appeals. When indicated, the Case Manager works with physicians on peer reviews with payer medical directors and ensures timely clinical updates and documentation of payer communications in Meditech. The position coordinates discharge needs and services, including home health, follow-up care, durable medical equipment and supplies, outpatient therapy, dialysis, skilled nursing, assisted living, hospice, and private-duty care. It ensures patient needs are coordinated before discharge for a safe, thorough plan and that patient choice is offered and documented in accordance with CMS Conditions of Participation for Discharge Planning. The role also identifies trends affecting quality, cost effectiveness, patient experience, and care delivery and brings them to departmental leadership for discussion and action.

Requirements

Current licensure as a Registered Nurse or Social Worker, or healthcare professional licensure as a Respiratory Therapist, Physical Therapist, Speech Language Pathologist, or Occupational Therapist.
Effective oral and written communication skills in English.

Nice To Haves

Certification in Case Management or Rehabilitation Nursing is preferred, such as CCM, ARN certification, ACM, or ANCC Board Certification in Case Management (RN-BC).
At least 2 years of social work or case management experience in an inpatient setting is highly preferred.
Acute or rehabilitation hospital experience is preferred.
Additional language skills are preferred.

Responsibilities

Coordinate weekly patient care team conferences to develop, monitor, and refine treatment plans toward patient goals and outcomes.
Review assigned CMGs and help identify potentially missed comorbid conditions actively treated during the patient’s stay; communicate findings to the HIM team.
Assist with concurrent and retrospective utilization review activities, including denials and appeals.
Work with physicians to conduct peer reviews with payer medical directors when indicated.
Provide clinical updates to insurance payers when due and document payer communications in Meditech.
Coordinate discharge planning services and needs, including home health, physician follow-up, durable medical equipment, medical supplies, healthcare services, outpatient therapy, dialysis, skilled nursing, assisted living, hospice, and private-duty care.
Coordinate patient care needs before discharge and ensure a safe, thorough discharge plan.
Offer and document patient choice as required by CMS Conditions of Participation for Discharge Planning.
Identify trends affecting quality, cost effectiveness, patient experience, and care delivery, and bring them to departmental leadership meetings for discussion and action.

Benefits

Multiple levels of medical, dental, and vision coverage for full-time and part-time employees.
Life, accident, critical illness, and hospital indemnity insurance.
Short- and long-term disability insurance.
Paid family leave.
A minimum of 10 days of paid time off per year for full-time employees.
Eight paid holidays per year.
Higher education and certification tuition assistance.
Loan assistance.
401(k) retirement package with company match.
Wellness programs, including free gym memberships, virtual care appointments, mental health services, and discount programs.
Ongoing learning and career advancement opportunities.