Regional Resource Case Manager Full Time

ScionHealth•Las Vegas, NV

12d

About The Position

The Regional Resource Case Manager serves as a case management subject matter expert and provides operational expertise across multiple Kindred hospitals. The role coordinates and facilitates patient care in collaboration with Interdisciplinary Care Transitions (ICT) members, following patients across the continuum of care to support appropriate resource utilization, service delivery, and compliance with external review requirements. The position provides comprehensive assessment, care planning, implementation, and evaluation of individual patient needs, integrating case management, utilization review and management, and discharge planning to promote continuity, satisfaction, and cost effectiveness. The Regional Resource Case Manager also serves as a mentor and preceptor to staff and provides education on resource utilization, discharge planning, and psychosocial aspects of healthcare delivery. The role partners with external customers, referral sources, and payors to coordinate discharge planning and advocates for patients and families. Travel is approximately 100%.

Requirements

Graduate of an accredited program as a Registered Nurse, or a Master of Social Work, or a Bachelor of Social Work; social work licensure must meet state requirements.
Healthcare professional licensure as a Registered Nurse, or as a Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) when required by state regulations.
Must read, write, and speak fluent English.
Basic computer skills, including 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.
Ability to demonstrate critical thinking, prioritization, and time-management skills.
Adaptable and flexible.
Regular attendance is required.
Willingness and ability to travel approximately 100%.

Nice To Haves

Bachelor of Science in Nursing (BSN).
Certification in Case Management.
Two years of experience in a healthcare setting, preferably acute care or LTACH.
Prior experience in case management, utilization review, or discharge planning.

Responsibilities

Serve as a subject matter expert in daily patient-care coordination, supporting the development, monitoring, and refinement of treatment plans.
Work with the Director of Case Management to support compliance with CMS, state, and JCAHO requirements and company policies, including documentation and record requirements.
Participate in surveys and audits.
Coordinate clinical and psychosocial activities with the interdisciplinary team and physicians.
Monitor patients’ stays for effective care coordination and efficient care facilitation.
Refer high-risk patients who may benefit from additional support and serve as a patient advocate.
Support patients and families in making informed decisions and provide education about post-hospital needs.
Participate in interdisciplinary patient-care rounds and conferences to review treatment goals and optimize resource utilization.
Collaborate with clinical staff and the interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others to develop and carry out care plans throughout the care continuum.
Conduct comprehensive, ongoing patient assessments and provide timely, safe discharge planning.
Use critical thinking to develop and execute effective discharge plans and communicate with patients and families.
Conduct medical-necessity reviews from admission through discharge and promote effective, efficient use of clinical resources.
Conduct timely, accurate clinical reviews and coordinate continued-stay authorization with payors.
Mentor and precept staff and provide education related to resource utilization, discharge planning, and psychosocial aspects of healthcare delivery.
Maintain current knowledge of reimbursement modalities, community resources, case management, and psychosocial and legal issues affecting patients and care providers.
Serve on hospital and division committees when requested.
Perform job responsibilities in accordance with the company’s Code of Business Conduct, policies and procedures, Corporate Compliance Agreement, applicable laws, and professional standards.
Perform other related duties as assigned.