Job Summary
Case Manager - Rehabilitation at Frye Regional Medical Center . Manager of Case Management in the department, lead in absence of Director, accountable for execution, adaptation and outcome of care management, resources, appropriateness and adherence to GMLOS for each patient.
Company Description
Frye Regional Medical Center, located in the beautiful foothills of North Carolina, is a 355‑bed acute care hospital, 81‑bed Behavioral Health facility providing more than 70 primary and specialty care providers.
Essential Functions
Monitors the daily assignment and makes adjustments to distribute the caseload evenly for CM, SW and D/C planners.
Keeps staff up to date on their time in Kronos; fixes missed punches.
Takes messages off the insurance line and communicates information to the correct persons.
Completes Retro’s and enters days authorized into Cerner for billing purposes.
Enters billing changes into Cerner so billing knows the correct way to bill; e.g., direct admits or bill differently than status.
Researches medical records to assist if business office or coding department has questions; also assists revenue integrity with questions.
Monitors all OBS patients to remain.
Follows discharges daily to ensure all days authorized for hospital stay.
Scribes for IDT Meeting daily and quarterly UM committee meetings.
Performs monthly audits as designated by the DCM; MCL and Patient choice; also completes missed final dispositions paperwork.
Notifies DCM and business of denials and enters on a denial log.
Fights denials by not accepting if not appropriate and constantly sending updated information and asking for re‐reviews.
Assists UR as needed with sending clinicals to insurances to keep information timely.
Participates in the hiring of new employees, as well as managing current staff needs.
Resource person for post‑acute services.
In director absence attends morning huddle, morning throughput meetings regarding DC for the day.
Is involved if and when state comes on site.
Benefits
Medical, Dental, and Vision plans with competitive options.
Health Savings Account (HSA).
401(k) retirement plan contributions.
Generous Paid Time Off.
Accident & Critical Illness Insurance.
Prescription Assistance with OptumRx.
Life insurance, Short/Long‑term Disability, and Identity Theft protection.
Employee Assistance Program at no cost.
Free travel and entertainment discount program.
Why join our team?
Frye Regional Medical Center employs more than 1,500 professional and clinical staff. Our medical center is a 355‑bed acute care facility offering a broad array of inpatient and outpatient care. Frye Regional Medical Center is dedicated to providing patients with a full range of services to meet the healthcare needs of our community. We believe our employees are our most valuable assets in accomplishing this goal and we have made great strides to ensure employee satisfaction. If you are passionate about changing lives, we are looking for you!
Minimum Education
Associate Degree in Nursing required. Bachelor’s Degree in Nursing preferred.
Licenses & Experience
Current RN license to practice in NC. Five years hospital‑based clinical experience. Experience in Case Management, Utilization Review, and Discharge Planning; knowledge of InterQual and other payor criteria required. Must have excellent communication skills, demonstrate self‑direction, and have the ability to work well in a team environment.
Equal Opportunity
Equal opportunity and affirmative action employers looking for diversity in candidates: Minority, Female, Disabled, Protected Veteran.