Job Description

The Case Manager facilitates effective patient care coordination, ensures appropriate resource utilization, and guides patients and families through the healthcare continuum. This full-time, on-site role focuses on improving patient outcomes, expediting care transitions, and ensuring compliance with regulatory and payer requirements.

Essential Duties:

• 🏥 Manage patient cases from admission through discharge.
• 🤝 Collaborate with healthcare providers to plan and coordinate care.
• 🏠 Facilitate discharge planning and placement.
• 📋 Evaluate medical necessity for admissions and continued stays.
• 📝 Ensure documentation supports medical necessity and discharge planning.
• 🗓️ Coordinate care team meetings and family conferences.
• 📚 Educate patients and families on post-discharge care needs.
• 📈 Participate in quality improvement initiatives.
• 📜 Maintain knowledge of CMS regulations, payer guidelines, and hospital policies.

Behavioral Standards:

• 👔 Follow dress code and ethical guidelines.
• ⏰ Respect customers' and co-workers' time.
• 📞 Utilize scripting for consistent customer service.
• ⚡ Respond quickly to requests and complaints.
• 📝 Attend staff meetings and follow HIPAA guidelines.
• 🤝 Partner effectively with interdisciplinary teams.

Education & Experience:

• 🎓 3-5 years of hospital case management or utilization review experience required.
• 🏥 Acute care or ICU case management experience preferred.
• 🩺 RN or LCSW in Texas required.
• 📜 Bachelor's degree in Nursing or Social Work required; BSN/MSW preferred.
• 🏅 Case Management Certification (ACM or CCM) preferred or obtained within 1 year of hire.

Job Tags

Similar Jobs