Case Manager

Emerus

About The Position

The purpose of this position is to provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The goal of the position is to enhance the quality of patient care through innovative and cost-effective best practices. This position promotes the integration of case management, utilization review, discharge planning, denial management and patient transfer management to ensure successful continuity care.

Requirements

Compact Registered Nurse (RN) license, required
2 years hospital clinical experience, required
Superior interpersonal skills
Ability to establish and maintain collaborative, effective working relationships
Ability to communicate professionally and effectively in oral, written and electronic formats
Demonstrate analytical and critical thinking abilities with proactive decision-making and negotiating skills
Demonstrate professional organizational skills
Ability to manage multiple tasks simultaneously
Position requires fluency in English; written and oral communication

Nice To Haves

Bachelor’s Degree, strongly preferred
Utilization Review/Case Management experience, preferred
Active Case Management Certification or other professional RN Certification, preferred
InterQual and/or Milliman experience, preferred

Responsibilities

Ensure patient progression through continuum of care
Ensure compliance during all admission and transfer processes
Document patient outcomes during and after each coordination of care
Maintain patient health information privacy at all times
Coordinate transfer center admission and/or transfer requests as required
Coordinate and complete daily patient continuum reports as required
Complete and ensure Utilization Review of all admissions
Maintain regulatory compliance with CMS Conditions of Participation
Record and report extended delays in care
Coordinate discharge planning
Monitor and update discharge planning resources
Perform denial management responsibilities
Coordinate payer communication
Act as a patient advocate: investigate and report adverse occurrences and perform staff education related to resource utilization, discharge planning and all other pertinent aspects of healthcare delivery
Collaborate with clinical staff in development and execution of the plan of care and achievement of goals
Minimal travel may be required
Perform other duties as assigned