Case Manager

Job Overview
We are seeking a dedicated and compassionate Case Manager to join our dynamic healthcare team. In this vital role, you will coordinate patient care plans, facilitate communication among multidisciplinary teams, and ensure seamless discharge planning and utilization management. Your expertise will help optimize patient outcomes, enhance care quality, and promote efficient resource utilization across various healthcare settings. This position offers an exciting opportunity to make a meaningful difference in patients’ lives while working within a collaborative, fast-paced environment. Duties

• Conduct comprehensive patient assessments, including medical history review and social determinants of health evaluation, to develop personalized care plans.
• Coordinate with healthcare providers, social workers, and family members to facilitate effective discharge planning and follow-up care.
• Review medical records and documentation to ensure compliance with HIPAA regulations and maintain accuracy in EMR (Electronic Medical Record) and EHR (Electronic Health Record) systems.
• Perform utilization review and management by evaluating the necessity, appropriateness, and efficiency of patient services across acute care, ICU, pediatrics, trauma centers, and hospice settings.
• Apply clinical knowledge of medical terminology, CPT coding, ICD-9/10 coding systems, ICD coding standards, and managed care protocols to support billing accuracy and reimbursement processes.
• Assist in intake procedures for new patients or cases requiring behavioral health or social work interventions, ensuring timely access to services.
• Collaborate on discharge planning efforts for complex cases involving Level I or Level II trauma centers, PICU (Pediatric Intensive Care Unit), or emergency medicine scenarios. Requirements
• Proven critical care experience with a strong background in hospital environments such as ICU, emergency medicine, or trauma centers.
• Nursing licensure or relevant healthcare certification with demonstrated experience in hospital medicine or acute care settings.
• Familiarity with ICD-10/ICD-9 coding systems, CPT coding, and utilization review processes.
• Experience working within EMR/EHR systems while maintaining strict adherence to HIPAA regulations for patient privacy and data security.
• Knowledge of social work practices, behavioral health considerations, discharge planning procedures, and managed care protocols.
• Strong understanding of medical terminology related to pediatrics, trauma centers (Level I & II), OR (Operating Room) experience preferred.
• Excellent communication skills with the ability to coordinate effectively across multidisciplinary teams in high-pressure environments such as Level I trauma centers or PICUs. Join our team as a Case Manager to play a pivotal role in delivering exceptional patient-centered care! We value your expertise in navigating complex clinical scenarios while fostering collaboration that leads to improved health outcomes for our diverse patient population.

Pay: $25.36 - $30.55 per hour

Work Location: In person