[Hiring] Case Manager - Utilization Management @McLeod Health

Role Description

The Case Manager oversees the process of care delivered to patients, works collaboratively, and provides leadership to the healthcare team, and is committed to organization goals. The role includes:

• Examining records for medical treatments and interventions to avoid payment denial, optimizing reimbursement by assessing appropriateness of treatments, effectiveness, timing, and setting.
• Assessing observation level of care vs inpatient level of care based on medical necessity.
• Conducting patient assessments for discharge planning and appropriateness of level of care.
• Coordinating/facilitating patient care progression throughout the continuum of care.
• Ensuring the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective.
• Meeting directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with the physician.
• Monitoring length of stay and ancillary resource use on an ongoing basis, taking actions to achieve continuous improvement.
• Communicating information to the Utilization Management or Case Management team to aid in appropriate level of care determination and reimbursement by third party payors.
• Working closely with the Physician Advisory team on concurrent denials to ensure the most appropriate level of care prior to billing.
• Monitoring patient flow through multidisciplinary rounds and aiding in implementation of processes for improvement to decrease delays.
• Serving as patient advocate to the ED population by identifying needs, coordinating services and resources for the management of complex patients.
• Ensuring that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team.
• Ability to cover various populations across the organization, including the Emergency Department.
• Performing all other duties as requested by Case Manager Supervisor and/or Director.

Qualifications

• 1-2 years of recent acute care hospital experience required.
• Data entry/computer experience required.

Requirements

• Registered Nurse license required.

Company Description

Founded in 1906, McLeod Health is a locally owned and managed, not-for-profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. The organization operates:

• Seven hospitals
• Three Health and Fitness Centers
• A Sports Medicine and Outpatient Rehabilitation Center
• Hospice and Home Health Services

The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals within McLeod Health include:

• McLeod Regional Medical Center
• McLeod Health Dillon
• McLeod Health Loris
• McLeod Health Seacoast
• McLeod Health Cheraw
• McLeod Health Clarendon
• McLeod Behavioral Health

If you would enjoy working in a dynamic environment and are looking for an opportunity to become part of a stellar team of professionals, we invite you to apply online today. We are an equal opportunity employer.