Case Manager / PRN ( RN / RT / SW / LPN )
Critical Illness Recovery Hospital. Requires a current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist or Social Work (SW/MSW) according to state guidelines. Previous experience in a critical care setting is required. Previous discharge planning experience is highly preferred.
Shift: Availability to work a minimum of 2 shifts per month on an "as needed" basis. Shifts will be scheduled on weekdays, approximately 8 a.m.–5 p.m.
The Case Manager is responsible for utilization reviews and resource management, discharge planning, treatment plan management, financial management, and medical record documentation. The role reports to the Director of Case Management and provides social work services as necessary per state guidelines.
Develops and implements a patient‑specific, safe and timely discharge plan.
Performs verification of utilization criteria reviews.
Builds relationships and coordinates with payor sources to assure proper reimbursement for hospital‑provided services, promoting cost‑attentive care via focus on resource management within the plan of care.
Demonstrates compliance with facility‑wide Utilization Management policies and procedures.
Coordinates UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
Maintains fiscal responsibilities, ensuring the department is identifying and negotiating the fullest possible reimbursement to maximize insurance benefit coverage for the patient. Reviews insurance verification forms to minimize risk.
Facilitates multi‑disciplinary team meetings including physicians, nurses, respiratory therapists and rehabilitation therapists.
Qualifications
Current licensure in a clinical discipline as a Nurse (RN/LPN/LVN) or a Respiratory Therapist or current license/certified Social Work license per state guidelines.
Previous RN/LPN/RT/SW/CM experience in an inpatient hospital setting dealing with critical care/acute care patients (e.g., ICU, step‑down, med‑surg, vents).
Adequate experience in an acute medical case management setting and confidence to manage and direct a plan of care for chronically critically ill populations.
Preferred qualifications
Specific experience in Care Management and Discharge Planning.
Working knowledge of the insurance industry and government reimbursement.
Availability to work a minimum of 2 shifts per month on an "as needed" basis – weekdays, approximately 8 a.m.–5 p.m.
Seniority level: Entry level.
Employment type: Part‑time.
Job function: Health Care Provider.
Industries: Wellness and Fitness Services, Hospitals and Health Care, and Medical Practices.