Case Manager ($15,000 Sign On Bonus)

CAMC Health System•Morgantown, WV

2d•Onsite

About The Position

The Case Manager collaborates with physicians and the multidisciplinary team to coordinate patient care, monitor progress, and ensure care plans and services are patient-focused, high quality, efficient, and cost-effective. The role coordinates patient education and discharge plans to support smooth transitions after discharge. The Case Manager conducts utilization review and management, supports discharge planning, and maintains timely, accurate documentation in accordance with payer requirements and hospital policies.

Requirements

Associate's degree required.
Registered Nurse credential required.
A minimum of five years of clinical experience in a hospital is preferred.
Knowledge of, or ability to learn, Quality Assurance, Utilization Review and Management, Discharge Planning, and Home Health utilization guidelines and their application.
Ability to communicate effectively with medical staff and administrative personnel.
Strong leadership and organizational skills.
Ability to organize complex information and paperwork systems.
Problem-solving and decision-making skills.
Ability to interact effectively with patients, families, and other healthcare workers.
Basic typing and computer skills, or ability to learn.
Ability to perform light work, including frequent lifting or carrying of objects up to 10 pounds and a maximum lift of 25 pounds.

Nice To Haves

A minimum of five years of clinical experience in a hospital.

Responsibilities

Administer the patient denial process and submit cases for appeals as needed.
Use InterQual criteria appropriately.
Collaborate and communicate with the multidisciplinary team throughout discharge planning, including assessment, planning, and implementation.
Coordinate and provide information to medical staff, clinical teams, patients, and families in accordance with hospital policies and procedures.
Communicate with patients and families about care plans and discharge preparation.
Review charts daily for readmissions and review charts for correct admission status and documentation improvement or query opportunities.
Work with social workers to coordinate transitions for patients ready for discharge and obtain the Important Message from Medicare signature before discharge.
Refer cases to the Coordinator or Physician Advisor and for peer review as appropriate.
Monitor quality indicators and refer deficiencies to the Coordinator.
Organize caseloads based on census, telephone reviews, and case complexity.
Conduct an initial review within 24 hours or the first business day after admission to assess medical necessity and appropriateness of care.
Exercise independent judgment, using reference materials, when performing certification.
Contribute as a team member to utilization of departmental resources.
Evaluate assigned cases for utilization management and documentation requirements, and provide information to managed care reviewers and hospital clinical staff.
Meet with patients to introduce the Case Manager and explain the role.
Manage length of stay, understand expected length-of-stay guidelines, and assist others with adherence.
Document utilization review processes and results for each third-party payer accurately and promptly, following service plans, guidelines, and hospital policies.
Document case management activities, care-plan implementation, and discharge planning according to established procedures.
Participate in hospital committees, build relationships with other departments, attend required in-services and staff meetings, and participate in self-education.
Complete required competency assessments on time and maintain job knowledge, licensure, credentials, and continuing education.
Perform other duties as required.