Openings >> Case Manager- Full Time
Case Manager- Full Time
Summary
Title:Case Manager- Full Time
ID:1462
Department:Case Management-917
Location:Phenix City, AL
Description

Jack Hughston Memorial Hospital is looking for a Case Manager for a Full Time position.

Shift: Days

Position Goal: Conducts discharge planning and utilization review activities for assigned patients. Completes initial discharge planning interview within twenty-four (24) business hours of admission. Coordinates discharge planning and utilization review activities. Identifies discharge needs including, but not limited to, the appropriate level of care at discharge, required home/outpatient services and any durable medical equipment required and follows utilization review accordingly. Communicates with payors and service providers to facilitate procurement of equipment and services required for discharge and as ordered by the physician. Completes data collection and quality activities as outlined by the Manager of the Department. Assists Manager of Case Management to help coordinate activities related to physician advisors and review committees. Assists Manager of Case Management in facilitating appropriate admissions and discharges to promote a high quality of care while preventing underutilization/over utilization of hospital resources. Conducts admission, concurrent and retrospective utilization reviews for all assigned patients. Reviews severity of illness and intensity of service indicators to assure that appropriateness of care criteria is met. Documents reviews in the medical record and/or the computer system as appropriate.

Position Responsibilities:

  • Demonstrates knowledge of Case Management Department Policies.
  • Conducts admission interview within twenty-four business hours of admission.
  • Determines the needs of the patient.
  • Conducts individualized discharge planning activities for assigned patients and communicates the plan to involved participants.
  • Accesses community resources to meet the needs of the patient.
  • Conducts follow-up activities to ensure effectiveness of discharge planning.
  • Monitors length of stay and appropriateness.
  • Assesses, plan, implements, coordinates and evaluates health related service options throughout continuum.
  • Completes data collection and activities as outlined by the Manager.
  • Participates in Patient Care Team Meetings.
  • Documents required information consistent with Jack Hughston Memorial Hospital Case Management policy and procedures.
  • Assist Manager of Case Management to help coordinate utilization review with Business Office/Revenue Cycle to ensure compliance, maximize reimbursement, monitor and coordinate issues such as when necessary RAC  audit and other audits as they relate to the revenue cycle.
  • Performs admission, observation, concurrent and retrospective reviews to evaluate the medical necessity of hospital services during the patient’s stay.
  • Coordinates the referral of cases to the Physician Advisor (PA) if not meeting approved criteria for admission or continued stay and distributes the Hospital Issued Notice of Non-coverage (HINN) when indicated. 

 

Experience: 2-3 years case management experience in acute care setting preferred
Education: Education required for LPN or RN licensure
Special Qualifications: Current LPN or RN Alabama Nursing License required. BLS required. Effective verbal and written communications skills; ability to read and write and follow oral and written instructions.

 

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or protected veteran status. This company is a VEVRAA Federal Contractor.

This opening is closed and is no longer accepting applications
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