Utilization - Case Manager
About The Position
Under the general supervision of the case management manager acts as a patient advocate/case manager to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. Looks for opportunities to reduce cost while ensuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care. Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care. The case manager is on-site and available seven days a week, as well as holidays and, therefore, is required to work a weekend rotation and an occasional holiday.
Requirements
- Healthcare professional with degree in health science strongly preferred BSN or MSW preferred
- Three to five years of acute care hospital experience preferred.
- Critical care or emergency department experience highly desirable.
- Immunity and organizational resources, patient care processes, and data analysis.
- Knowledge of utilization management as it relates to third-party payers.
- Knowledge of post acute care community resources.
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What This Job Offers
Job Type
Full-time
