Case Manager

University of Utah Health•Salt Lake City, UT

About The Position

University of Utah Health seeks a Case Manager to provide clinical case management services that enhance patient-centered care and maximize outcomes across the patient care continuum, from pre-admission through post-discharge, including outpatient settings. The position monitors care and progress toward desired outcomes, addresses patient and family needs, resolves barriers to effective care, and coordinates services with payers, vendors, patients, families, and healthcare team members. In collaboration with the team, the Case Manager establishes, monitors, and executes discharge plans. The role may require accessing and administering medications within the employee’s scope of practice and applicable state law. The Case Manager works in a complex, 24/7 health system and may be assigned rotating schedules, including variable hours, nights, weekends, and holidays, according to department and patient-care needs. Regular, reliable, and punctual attendance during assigned shifts is essential. Depending on the department, reliable transportation may be needed for site visits. The position does not provide direct patient care, but may involve exposure to infectious diseases and working around prisoners or behavioral health patients. The job involves light work, including lifting, carrying, pushing, pulling, or otherwise moving objects weighing up to 20 pounds, and may involve patient-care or medical equipment.

Requirements

At least two years of professional experience in a clinically related area.
Current Utah license to practice as a Registered Nurse, or obtain one within 90 days of hire under the interstate compact when changing residency to Utah; maintain a current interstate compact multi-state license if residency is not changing to Utah.
Alternatively, a current Utah Licensed Clinical Social Worker (L.C.S.W.) certificate for clinical practice.
Alternatively, a current Utah license to practice as a Clinical Mental Health Counselor.
Alternatively, a current Utah license to practice as a Physical Therapist, or obtain one within 90 days of hire under the Physical Therapy Compact when changing residency to Utah; maintain a current Physical Therapy Compact multi-state license if residency is not changing to Utah.
Alternatively, current Utah licensure to practice as an Occupational Therapist.
Meet any additional license requirements determined by the hiring department.
Demonstrate ability to perform the essential functions of the job.
Demonstrate availability to work variable and rotating shifts, including nights, weekends, and holidays, in a 24/7 patient-care environment.
Demonstrate team leadership, relationship-building, critical-analysis, and written and verbal communication skills.
Have knowledge of funding resources, clinical standards, and outcomes.
Be able to provide care appropriate to the population served.
Demonstrate independent judgment in assessing and meeting client needs.
Be able to conduct meaningful, outcome-oriented dialogues with patients, families, patient-care disciplines, ancillary departments, healthcare and community agencies, third-party payers, and Health Science Center professional schools to coordinate care and services.
Demonstrate knowledge of life-span growth and development and the ability to assess patient-status data and provide care as described in department policies and procedures.
Be able to meet the stated working-condition and physical requirements with or without accommodation.
Depending on the hiring department, may need reliable transportation for site visits.

Nice To Haves

Basic Life Support Health Care Provider card through the American Heart Association.
Certified Case Management designation.
Previous experience in clinical resource management activities and third-party payer interactions.

Responsibilities

Coordinate case management from a patient’s entry into the healthcare system through post-discharge, including outpatient settings.
Coordinate care and resources with physicians, social workers, and other team members to achieve optimal patient outcomes.
Identify patients appropriate for case management intervention based on cost, case complexity, admission frequency, or requests from patients, families, providers, or other healthcare team members.
Monitor and document quality of care, ensuring care-plan goals are appropriate, understood, and implemented.
Assess patient and family responses to services and evaluate the effectiveness and ongoing necessity of care plans.
Identify patient needs, including ethical and cultural needs, and ensure they are addressed.
Determine appropriate levels of care using diagnosis, severity, service intensity, relevant criteria, length-of-stay standards, and community norms to support cost-effective outcomes.
Assess and discuss funding and insurance issues with patients, families, and healthcare providers.
Negotiate with third-party payers regarding benefit levels, eligibility, utilization review, and reimbursement.
Identify actual and potential delays in service requests or treatment, communicate them to the healthcare team, and help eliminate or minimize delays.
Collaborate with team members to plan appropriate and timely discharges.
Establish measurable discharge-planning and self-management goals that promote safe, cost-effective, high-quality outcomes.
Oversee issuance of the CMS Important Message to patients.
Supervise technical support staff assigned to individual case management teams.
As needed, arrange patient follow-up appointments and conduct post-discharge phone calls according to care-team design.
Complete home or site visits when required by the department.
Work assigned rotating schedules, potentially including variable hours, nights, weekends, and holidays, to meet staffing and patient-care demands.
Maintain regular, reliable, and punctual attendance during assigned shifts.