Job description

Works under the supervision of the Director of Admissions. The Internal Case Manager coordinates the care and service of selected patient populations across the continuum of care; promote effective utilization and monitoring of health care resources; maintain accurate knowledge base of payer.

Case Management services are generally focused on members who fall into one or more high risk or high cost groups and require significant clinical judgment, independent analysis, critical-thinking, detailed knowledge of departmental procedures, clinical guidelines, community resources, contracting and community standards of care. Case Management includes assessment, coordination, planning, monitoring and evaluation of multiple environments.

Must be licensed RN/LPN in the Commonwealth of Virginia.

Must be fully COVID vaccinated.

• Coordinates the integration of social services/case management functions into the patient care, discharge and home planning processes with other departments, external service organizations, agencies and healthcare facilities.
• Conducts concurrent medical record review using specific indicators and criteria as approved by medical staff.
• Promotes effective and efficient utilization of clinical resources and mobilizes resources to assist in achieving desired clinical outcomes within specific time frame.
• Reviews appropriate utilization of services from admission through discharge. Evaluates patient satisfaction and quality of care provided.
• Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assists physicians in maintaining appropriate cost, case and desired patient outcomes.
• Responsible for the coordination of health care decisions by using a systematic approach to assure treatment plans that improve quality and outcomes.
• Working with the complex care needs.
• Identifying gaps or barriers in treatment plans.
• Promotion of cost-effective care within the allotted time frame
• Assuring payments of hospital-based services meeting patient-related utilization management criteria
• Implementation of safe and appropriate discharge plans.
• Liaison between the facility and the insurance company for the benefit of the patient

Job Type: Full-time

Pay: $30.00 - $35.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Case management: 1 year (Preferred)

Work Location: One location

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