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Case Manager
The Case Manager coordinates all authorizations and reauthorizations for patient services, identifies care needs for safe and appropriate discharge planning, ensures compliance with third-party payers, and acts as Utilization Review liaison with Health Information Management (HIM).
Registered Nurse or a Social Worker
Current WY RN license or a bachelor's in social work
Two to three years' experience in hospital setting preferred
Experience with hospital, SNF, and health plan-based case management systems preferred
BLS required
- Assist with the development, implementation, and ongoing evaluation of the Case Management System, including collaboration with clinical departments and community resources.
- Direct, coordinate, and deliver case management for patients, including assessment of needs, planning interventions, monitoring effectiveness, and maintaining required documentation.
- Participate in case finding, pre-admission evaluation, and screening for optimal reimbursement and proactive discharge planning.
- Perform comprehensive case management assessments and prepare transition plans that optimize clinical and psychosocial outcomes, involving family and outside agencies as needed.
- Supply clinical information to third-party payers to ensure continued reimbursement and timely authorizations.
- Communicate and collaborate with the healthcare team to optimize resource utilization, anticipate barriers, and facilitate timely and appropriate discharge planning.
- Identify, refer, and facilitate admissions to Transitional Care Center (TCC) and other appropriate referral organizations, monitoring criteria and readiness.
- Prepare, update, and maintain records, reports, and written transfer/discharge plans, following all regulatory and institutional requirements.
- Establish and maintain external relationships with referral sources, insurers, vendors, and external case managers, ensuring effective communication and care continuity.
- Maintain a professional commitment, flexibility, and current knowledge of relevant guidelines, CEU credits, and resources for case management and discharge planning.
- Assure department delivers high-quality services meeting regulatory standards and participating in quality improvement program reporting.
- Achieve agreed-upon goals and objectives within prescribed timelines, supporting the hospitals overall mission.
- Follows all exposure control plans for bloodborne/airborne pathogens and maintains compliance with protective barrier policies and annual education.
- Promote effective working relationships, foster a supportive team environment, participate in meetings, and support the hospital’s mission and policies.
- Behave and dress in a professional and courteous manner consistent with the facilities Standards of Behavior.
- Perform other duties as assigned
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