Case Manager

University of Utah Health•Midvale, UT

About The Position

This position provides clinical case management services to enhance patient-centered care and maximize outcomes across the patient care continuum, from pre-admission through post-discharge, including outpatient settings. The Case Manager monitors patient care and progress toward desired outcomes; addresses patient and family needs; resolves obstacles to effective care; and coordinates care with payers, vendors, patients, families, physicians, social workers, and other team members. The Case Manager works with the care team to establish, monitor, and execute patients’ discharge plans. The role may require accessing and administering medications within the employee’s scope of practice and in accordance with state law. University of Utah Health is a patient-focused organization dedicated to improving health and well-being through patient care, research, and education. The University of Utah is a Level 1 Trauma Center with five hospitals and eleven clinics, and is recognized for academic research, quality standards, and patient experience. The position may require rotating schedules, including variable hours, weekends, nights, and holidays, to meet the staffing and patient-care demands of a 24/7 health system. Regular, reliable, and punctual attendance during assigned shifts is an essential function. Depending on the department, the role may require reliable transportation for home or site visits. The work involves light physical demands and possible exposure to infectious diseases; employees may also work around prisoners or behavioral health patients. The position does not provide direct patient care.

Requirements

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 multistate compact 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 multistate compact 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.
Ability to perform the essential functions of the job.
Availability to work variable and rotating shifts, including nights, weekends, and holidays, in a 24/7 patient-care environment.
Demonstrated team leadership, relationship-building, critical-analysis, written communication, and verbal communication skills.
Knowledge of funding resources, clinical standards, and outcomes.
Ability to provide care appropriate to the population served.
Independent judgment to assess and meet client needs.
Ability 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.
Knowledge and skills necessary to provide care appropriate to the ages of patients served in the assigned area.
Knowledge of lifespan growth and development and ability to assess patient-status data and provide care according to departmental policies and procedures.
Ability to meet physical requirements with or without accommodation, including light work that may involve lifting, carrying, pushing, pulling, or moving objects weighing up to 20 pounds.
Reliable transportation for site visits may be required, depending on the department of hire.

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, frequency of admission, or requests from patients, families, providers, or other healthcare team members.
Monitor and document quality of care to ensure care-plan goals are appropriate, understood, and implemented; assess patient and family responses and evaluate care-plan effectiveness and necessity.
Identify patient needs, including ethical and cultural needs, and ensure they are addressed.
Determine an appropriate level of care using diagnosis, severity, service intensity, relevant criteria, length-of-stay standards, and community norms to facilitate cost-effective outcomes.
Assess and discuss funding and insurance issues with patients, families, and healthcare providers to support cost-effective utilization and quality outcomes.
Negotiate with third-party payers regarding benefit levels, eligibility, utilization review, and reimbursement.
Identify actual and potential delays in service requests or treatment and communicate them to the healthcare team so delays can be eliminated or minimized.
Work 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 case management teams.
As needed, arrange follow-up appointments and conduct post-discharge phone calls to patients according to the care team’s design.
Complete home or site visits when required by the department.
Provide care appropriate to the age and population served and apply knowledge of lifespan growth and development to assess patient status and provide care in accordance with departmental policies and procedures.
Work assigned rotating schedules, which may include variable hours, nights, weekends, and holidays, to meet patient-care and staffing demands.