Case Manager PRN
About The Position
At ScionHealth, caregivers are empowered to provide excellent care, and the organization emphasizes respect, courage, curiosity, and collaboration. The Case Manager coordinates and facilitates patient care through collaboration and communication with Interdisciplinary Care Transitions (ICT) team members. The role follows patients across the continuum of care and supports appropriate resource utilization, service delivery, and compliance with external review agencies. It provides ongoing expertise through assessment, care planning, plan implementation, and evaluation of individual patient needs, integrating case management, utilization review and management, and discharge planning to support quality, continuity, patient satisfaction, and cost effectiveness.
Requirements
- Graduate of an accredited LPN/LVN or RN program, or a Master of Social Work or Bachelor of Social Work, with licensure as required by state regulations.
- Healthcare professional licensure as an LPN/LVN, Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.
- One year 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.
- Knowledge of accreditation standards and compliance requirements.
- Fluent in reading, writing, and speaking English.
- 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.
- Regular attendance is required.
Nice To Haves
- Experience in case management, utilization review, or discharge planning.
Responsibilities
- Coordinate clinical and psychosocial activities with the Interdisciplinary Team and physicians.
- Support effective care coordination and efficient care facilitation.
- Maintain current knowledge of reimbursement modalities, community resources, case management, and psychosocial and legal issues affecting patients and care providers.
- Refer high-risk patients who may benefit from additional support and serve as a patient advocate.
- Apply knowledge of growth and development across the lifespan to provide age-appropriate care.
- Participate in interdisciplinary patient care rounds and conferences.
- Collaborate with clinical staff to execute plans of care and achieve goals.
- Under appropriate supervision, conduct comprehensive, ongoing patient and family assessments to support timely and safe discharge planning.
- Assist with comprehensive discharge planning and use critical thinking to plan effectively.
- Conduct medical-necessity reviews for appropriate utilization of services from admission through discharge.
- Promote effective and efficient utilization of clinical resources.
- Conduct timely and accurate clinical reviews and coordinate care and continued-stay authorization with payors.
- Perform duties in accordance with the Company’s Code of Business Conduct, policies and procedures, Corporate Compliance Agreement, applicable laws, and professional standards.
- Serve on Hospital and Division committees when requested.
- Perform other related duties as assigned.
