Shift: 8:00AM - 5:00PM ET
Position Goal
The Case Manager is responsible for performing care coordination, utilization review support, and discharge planning. This includes assessment, identification of specific patient needs, and social service intervention while in the hospital setting. Licensed Practical Nurse and Bachelors of Social Work Case Managers will perform discharge planning, care coordination, utilization review support activities, and patient education consistent with Alabama Board of Nursing regulations and hospital policy. Activities requiring RN assessment, clinical judgment, or independent determination of medical necessity shall be referred to or completed by an RN Case Manager
Position Responsibilities:
- Demonstrates knowledge of Case Management Department Policies.
- Conducts admission interview within twenty-four business hours of admission.
- Assesses, plans, implements, coordinates and evaluates health related service options throughout continuum of care.
- Reviews severity of illness and intensity of service indicators to assure that appropriateness of care criteria is met.
- Accesses community resources to meet the needs of the patient.
- Determines the needs of the patient.
- Documents reviews in the medical record and/or the computer system as appropriate.
- Completes data collection and activities as outlined by management.
- Documents required information consistent with Hospital policies and procedures.
- Coordinates utilization review with Business Office/Revenue Cycle to ensure compliance, maximize reimbursement, monitors and coordinates issues related to audits.
- 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.
- Conducts follow-up activities to ensure effectiveness of discharge planning.
- Communicates with payors and service providers in order to facilitate procurement of equipment and services required for discharge as ordered by the physician.
- Conducts individualized discharge planning activities for assigned patients and communicates the plan to involved participants.
- Participates in Patient Care Team Meetings.
Experience:
Preferred:
- Two (2) to three (3) years of case management, discharge planning, care coordination, or acute care hospital experience.
Education:
Required:
- Bachelor’s Degree in Social Work (BSW); or
- Graduate of an accredited Registered Nursing program; or
- Graduate of an accredited Licensed Practical Nursing program.
Special Qualifications:
Required:
- Current Alabama or multistate licensure as a Registered Nurse (RN) or Licensed Practical Nurse (LPN), if applicable. Must be able to communicate effectively using both verbal and written communications skills.
- Must be able to work independently and use sound judgment.
- BLS certification through American Heart Association or American Red Cross
The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast 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 veteran status.