Case Manager

Gothenburg Memorial Hospital•Gothenburg, NE

19h

About The Position

The Case Manager is responsible for coordinating patient-centered discharge planning, conducting utilization review activities, and providing oversight of the Swing Bed Program. This role ensures safe transitions of care, appropriate utilization of hospital resources, and compliance with Critical Access Hospital (CAH), CMS, state, and payer requirements. The Case Manager collaborates closely with physicians, nursing, therapy, and interdisciplinary team members to support quality outcomes across acute and swing bed patient populations.

Requirements

Current Nebraska licensure as a Registered Nurse (RN) or Bachelors of Social Worker (BSW), or Licensed Independent Social Worker (LISW/LCSW) or Master of Social Work (MSW).
Required 2 years of clinical experience, preferably in a Critical Access Hospital or rural health setting.
Knowledge of discharge planning, utilization review, and swing bed program operations.
Strong communication, organization, and documentation skills.
Ability to work independently and exercise sound professional judgment
Current BLS certification.

Nice To Haves

Experience with swing bed programs and CMS CAH regulations.
Familiarity with utilization management tools.
Experience coordinating care across acute, restorative, and post-acute settings.

Responsibilities

Initiates discharge planning assessments for acute and swing bed patients upon admission and continues throughout the patient stay.
Collaborates with providers, nursing, therapy, and ancillary staff to develop and execute individualized discharge plans.
Coordinates post-acute services including swing bed admissions, skilled nursing facilities, home health, hospice, durable medical equipment, and community resources.
Ensures discharges are timely, safe, and aligned with patient goals, caregiver capacity, and rural resource availability.
Provides patient and family education related to discharge plans, follow-up care, and community services.
Documents all discharge planning activities in compliance with hospital policies and regulatory standards.
Performs admission, continued stay, and discharge reviews for both acute and swing bed patients to ensure medical necessity and appropriate level of care.
Applies approved utilization review criteria using hospital-approved tools.
Identifies opportunities for level-of-care transitions, including acute-to-swing-bed conversion.
Communicates utilization concerns with providers and supports accurate, compliant documentation.
Participates in utilization review committee activities, including reporting and case presentations as required.
Provides operational and clinical oversight of the Swing Bed Program in collaboration with the interdisciplinary care team.
Coordinates swing bed admissions, ongoing stay management, and discharges to ensure regulatory compliance and continuity of care.
Verifies patient eligibility and appropriateness for swing bed admission in accordance with CMS swing bed requirements.
Facilitates interdisciplinary collaboration among nursing, therapy, providers, dietary, social services, and ancillary departments for swing bed patients.
Monitors length of stay, progress toward goals, and discharge readiness for swing bed patients.
Serves as the primary coordination point for transitions between acute care, swing bed status, and discharge to the community or higher level of care.
Ensures compliance with CMS Conditions of Participation, CAH regulations, swing bed requirements, and payer standards.
Supports quality initiatives related to length of stay, readmissions, swing bed utilization, and transitions of care.
Assists with audits, data collection, and performance improvement activities related to case management and swing bed services.
Acts as a liaison among patients, families, providers, payers, and community partners.
Participates in interdisciplinary rounds, care conferences, and discharge planning meetings.
Identifies and escalates barriers to care progression or discharge in a timely manner.