Case Manager SE

Advocate Health and Hospitals Corporation • Wake Forest, NC

2d

About The Position

The Case Manager conducts patient assessments, develops plans, and coordinates interventions, care transitions, and discharge planning. The role collaborates with patients, families, and the healthcare team to support patient choice and satisfaction while meeting care and organizational goals. It provides case management across health care, financial, housing, family, and illness-adjustment needs, as applicable to department scope, and uses community resources and referrals to support timely progression of care.

The Case Manager performs and documents utilization reviews and discharge-planning activities in accordance with department, medical-center, and regulatory standards. The role partners with Social Work, medical staff, hospital departments, ancillary services, managers, physicians, and external organizations to address barriers to discharge, coordinate services, support appropriate admission status, and manage utilization-management activities. It also educates staff on care coordination, discharge planning, acute care criteria, and relevant regulations.

The position requires knowledge and skills to provide age-appropriate care across the lifespan. The typical schedule is Monday through Friday, 8 a.m. to 5 p.m.; an occasional weekend shift may be volunteered to cover vacations. The position is full time, with 40 hours per week, and is benefits eligible. The listed pay range is $38.20 to $57.30.

Requirements

• Graduate of a Board of Nursing-approved nursing education program as a Registered Nurse.
• Current RN license or temporary license as a Registered Nurse Petitioner in the state where the employee works and resides; alternatively, if declaring a National License Compact state as the primary state of residency, meet home-state licensure requirements. For non-NLC states, hold a current or temporary RN license as applicable.
• Typically, 3 years of related nursing experience.
• Clinical experience within the assigned population.
• Extensive knowledge of disease processes and clinical outcomes.
• Ability to prioritize and organize work.
• Effective communication skills.
• Ability to use critical thinking and make timely decisions.
• Ability to navigate an Electronic Health Record.
• Basic ability to use MS Office products.
• Knowledge of Medicare A and B guidelines.
• Knowledge of Managed Care program requirements and implications.
• Ability to apply elements of Utilization Management programs.
• Ability to meet the stated physical requirements, including sitting, standing, walking, lifting, manual dexterity, visual acuity, and verbal and hearing communication requirements.

Nice To Haves

• Bachelor of Science degree in Nursing (BSN).
• Case Management experience or background.
• Strong critical-thinking and analytical skills.
• Appropriate professional certification, preferred within 3 years of hire.

Responsibilities

• Conduct complete assessments, establish appropriate plans, and initiate interventions within desired timeframes.
• Collaborate and negotiate with patients, families, and the care team to support patient care needs, choice, and satisfaction during discharge planning and transitions.
• Involve patients, families, and the care team in decision-making, using patient and family strengths in problem-solving beginning at admission and throughout the hospital stay.
• Provide continuity of care and discharge-planning services in compliance with regulatory standards, coordinating relevant options and services based on assessed needs.
• Facilitate smooth transitions when patients are transferred by coordinating communication among patients, families, and staff.
• Provide case management related to health care, finances, housing, family discord, and illness adjustment within department scope; manage family dynamics and crises, use community resources, and educate patients and families about services.
• Initiate internal and external referrals to support timely progression of care and transitions.
• Document discharge-planning interventions and utilization-review activity in a timely manner according to department and medical-center standards.
• Perform and document accurate, timely concurrent and retrospective reviews using approved criteria.
• Communicate effectively with the healthcare team and partner with Social Work and unlicensed support personnel to establish and implement a safe plan of care.
• Participate as an active member of the MDR and work with medical staff, hospital departments, and ancillary services to identify and resolve discharge barriers, expedite care, and implement and report care coordination, discharge-planning, and utilization-management activities.
• Collaborate with managers, physicians, medical directors, advisory groups, and treatment teams on physician practices and best practices for patient care plans.
• Refer cases to a physician advisor as needed to support efficient care progression, accurate status, and regulatory compliance.
• Maintain knowledge of healthcare regulations, reimbursement issues, length-of-stay impacts, and community resources.
• Complete utilization-management activities according to local structure, including providing clinical updates to payers or external review organizations, collecting data, coordinating denial activity, supporting utilization-management work, and managing avoidable delays.
• Deliver CMS regulatory notices within established timeframes, as appropriate under site guidelines.
• Develop and maintain productive relationships with community agencies and networks, representing Advocate Health Care positively and collaborating to meet patient and family needs.
• Collaborate with Advocate Ambulatory Care Management and Continuing Health to support shared goals and outcomes.
• Educate and serve as an expert resource to medical and hospital staff on admission status, acute care criteria, utilization-management issues, care coordination, discharge planning, and relevant regulatory requirements.
• Demonstrate knowledge of lifespan growth and development, assess patient-status data, identify age-specific needs, and provide care in accordance with departmental policies and procedures.

Benefits

• Paid time off programs.
• Medical, dental, vision, life, and short- and long-term disability benefits.
• Flexible Spending Accounts for eligible health-care and dependent-care expenses.
• Adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.
• Premium pay such as shift and on-call pay, based on the teammate's job.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree