Case Manager PRN

ScionHealth • Dayton, OH

7d

About The Position

At ScionHealth, the Case Manager coordinates and facilitates care for the patient population through collaboration and communication with Interdisciplinary Care Transitions (ICT) team members. The role follows patients throughout the continuum of care and supports optimal resource utilization, service delivery, and compliance with external review agencies. It provides ongoing expertise through comprehensive assessment, care planning, implementation, and evaluation of individual patient needs, integrating case management, utilization review and management, and discharge planning to improve patient management, satisfaction, continuity of care, and cost effectiveness.

The Case Manager coordinates clinical and psychosocial care with interdisciplinary teams and physicians, monitors care coordination during the patient’s stay, advocates for patients, and supports informed decisions by patients and families. The role collaborates with clinical staff and care partners to develop and carry out care plans and coordinates discharge planning and utilization reviews from admission through discharge. The position also follows the Company’s conduct standards, policies, applicable laws, and professional standards, and may serve on hospital or division committees when requested.

The position requires a postsecondary nursing education credential from an accredited nursing school and an RN license or applicable social work credential. A bachelor’s degree in nursing or social work is preferred. At least two years of healthcare-setting experience is required; prior case management, utilization review, or discharge-planning experience is preferred.

Requirements

• Postsecondary certificate, diploma, or program completion from an accredited school of nursing.
• RN state licensure or compact state licensure in the state of practice, or an LCSW/LSW credential, required upon hire.
• At least 2 years of experience in a healthcare setting.
• Knowledge of government and non-government payor practices, regulations, standards, and reimbursement.
• Knowledge of Medicare benefits, insurance processes and contracts, accreditation standards, and compliance requirements.
• Critical thinking, prioritization, and time-management skills.
• Basic computer skills and working knowledge of Microsoft Office, word-processing, and spreadsheet software.
• Excellent interpersonal, verbal, and written communication skills to obtain cooperation and collaboration from hospital leadership, physicians, payors, and external customers.
• Good interpersonal skills when interacting with patients, families, and staff.
• Fluent English reading, writing, and speaking skills.
• Good and regular attendance.

Nice To Haves

• Bachelor’s degree in nursing or social work (BSN, MSN, BSW, or MSW).
• Prior experience in case management, utilization review, or discharge planning.
• Social Work Case Manager Certification (CSWCM).

Responsibilities

• Coordinate clinical and psychosocial activities with the Interdisciplinary Team and physicians.
• Monitor patient stays to support effective care coordination and efficient care facilitation.
• Refer high-risk patients who may benefit from additional support and serve as a patient advocate.
• Support collaborative relationships that help patients and families make informed decisions.
• Apply knowledge of growth and development across the lifespan to provide age-appropriate care.
• Participate in interdisciplinary patient-care rounds or conferences to review treatment goals, optimize resource use, provide family education, and identify post-hospital needs.
• Collaborate with clinical staff to develop and execute plans of care and achieve goals.
• Coordinate patient care throughout the continuum with interdisciplinary care teams, physicians, patients, families, post-acute providers, payors, and others.
• Conduct comprehensive, ongoing patient assessments and provide timely, safe discharge planning.
• Develop and execute effective discharge plans and communicate with patients and families.
• Conduct medical-necessity reviews from admission through discharge and promote efficient use of clinical resources.
• Complete timely and accurate clinical reviews and coordinate continued-stay authorization with payors.
• Perform duties in accordance with company conduct standards, policies, compliance requirements, applicable laws, and professional standards.
• Serve on hospital and division committees when requested.
• Perform other related duties as assigned.

What This Job Offers

• Education Level: Associate degree