Case Manager

Job summary
Autonomous role coordinating, negotiating, and managing care of complex patientsFacilitates achievement of quality and cost-efficient patient outcomesWorks collaboratively with interdisciplinary staff internal and external to the Organization
Job seniority: mid-to-senior level
Responsibilities
• Review medical records to ensure appropriate utilization and delivery of care• Utilize criteria to determine medical necessity for observation and continued stays• Communicate with attending physicians on documentation requirements and non-coverage• Coordinate patient care rounds and facilitate timely and safe discharge plans• Identify transition planning problems, set up required services, and facilitate care delivery options• Assess patient acute care needs and implement interventions for safe and timely discharge• Interact and communicate with multidisciplinary healthcare team to maximize resource utilization• Establish and maintain effective communication with referral sources and payers• Maintain knowledge of provider benefits, community resources, and regulatory requirements• Ensure department operational excellence and participate in quality improvement initiatives• Embrace technological solutions to work processes and practices
Requirements
• Registered Nurse with a Bachelor's degree preferred• 3-5 years acute care hospital experience preferred• Knowledge of negotiation, communication, conflict management, and critical thinking skills• Familiarity with healthcare financing, patient care processes, and data analysis• Experience with utilization management and post-acute care community resources• Excellent verbal and written communication skills• Flexibility and ability to adapt to changing priorities and regulations
Key Skills Needed
• Negotiation• Communication• Conflict resolution• Interdisciplinary collaboration• Management• Creative problem solving• Critical thinking• Time management• Multitasking• Data analysis