Welcome page Returning Candidate? Log back in! Manager, Case Management Job Locations US-IL-Decatur ID 2024-25647 Category Professional and Leadership Position Type Full-Time Overview

Manages the operation of Case Management to ensure appropriateness of admission, length of stay and use of resources to effectively meet all utilization criteria on a concurrent basis.

Qualifications

Must be an R.N. or B.S.N.  Five years experience in clinical nursing or discharge planning is required.

Responsibilities Plans and organizes the daily operation of Case Management.Assists in the performance of admissions, concurrent and focused reviews using Severity of Illness/Intensity of Service standard in accordance with InterQual criteria.Assists in the maintenance of appropriate documentation.Assists in the performance of telephone reviews as requested to obtain pre-certification and continued stay certification with private carriers and/or review firms.Closely monitors assessments to ensure case managers are assessing and evaluating patients’ potential for home maintenance; develops discharge plan with involved caregivers.Assists with making referrals to related agencies.Provides information to social service/discharge planners to facilitate discharge-planning process.Participates in multidisciplinary care conferences with other departments.Serves as a resource person to physicians and hospital staff in the appropriate use of health care resources.Serves as a liaison with nursing and medical staff and community agencies to facilitate problem solving and to coordinate services.Assesses and develops plan within scheduled time frame utilizing software applications – Star Utilization Management module and InterQual criteria.Remains current on all regulations of federal Medicare, intermediary, Blue Cross, Illinois Public Aid, and other third-party carriers; establishes guidelines, policies, and procedures to ensure compliance with such regulations.  Interacts effectively with external agencies, resolving problems expeditiously.Takes responsibility for upgrading professional skills and knowledge.  Remains current on all regulations for state and federal guidelines in association with InterQual criteria and other review agencies.Prepares and completes reports; participates in special projects.Demonstrates clinical competency by providing direct patient care in a designated clinical area on a routine basis.Performs other duties as assigned. Options Apply for this job onlineApplyShare Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Share on your newsfeed Connect With Us! Not ready to apply? Connect with us for general consideration. Application FAQs

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