Access Case Manager

Pioneers Memorial Healthcare District; California (MO); On-site; USD 50,000 - 70,000; Full time

Job summary

A healthcare provider in Missouri is looking for an experienced Access Case Manager to evaluate medical necessity for admissions and coordinate discharge planning. The role requires strong analytical, organizational, and interpersonal skills, as well as recent hospital experience and a Bachelor's degree in Nursing or related field. The Access Case Manager will work closely with physicians and the healthcare team to ensure optimal patient care transitions.

Qualifications

• Recent hospital experience, preferably ICU or CCU.
• Minimum 3 years of Med/Surg experience.
• Experience in Hospital Case Management preferred.

Responsibilities

• Evaluate medical necessity for admission and patient care placement.
• Coordinate unexpected discharge planning needs.
• Communicate with physicians for clinical practice implementation.
• Support patients with financial or psychosocial needs.

Skills

Organization

Analytical skills

Interpersonal skills

Critical thinking

Problem solving

Knowledge of Pathophysiology

Knowledge of Medicare

Education

Bachelor’s Degree in Nursing or related field

Certification in Case Management (preferred)

Current American Heart Association BLS

Job description

The Access Case Manager evaluates the medical necessity for admission, status and appropriateness of patient care unit placement for all scheduled admissions, direct admits, transfers, and outpatient conversions and provides consultation to physicians prior to patient placement. The Access Case Manager will coordinate any unexpected discharge planning needs for this patient population that are not transitioned to the inpatient case manager so that a smooth transition from the acute outpatient care setting to the community setting is ensured and readmission is averted. Refers to Social Work those patients with complex psychosocial or discharge planning needs and follows-up to ensure appropriate intervention.

Acts as a resource to ensure appropriate reimbursement for all scheduled procedures.

Dialogues with the payers as necessary to guarantee appropriate reimbursement for outpatients and scheduled admissions. Communicates with physicians and other members of the interdisciplinary healthcare team to ensure implementation of clinical practice guidelines or standing orders to meet expected standards of care for patients. Provides support and information to patients/families with identified financial or psychosocial needs. Serves as the liaison for the other members of the interdisciplinary team to ensure appropriate and expedient referrals upon decision to admit to the acute care inpatient setting

Key Skills

• Organization, analytical, writing, and interpersonal skills.
• Dependable, self-directed, and pleasant.
• Critical thinking, problem solving and deductive reasoning skills.
• Recent hospital experience preferably ICU, CCU, or strong minimum 3 years Med/Surg. Experience.
• Knowledge of Pathophysiology and Disease Process.
• Knowledge of Medicare, Medicaid, Managed Care Health Plans.
• Experience in Hospital Case Management preferred.

Education and Certification

1. 1. Bachelor’s Degree in Nursing, medicine, or related field.
2. 2. Certification in Case Management preferred or obtained certification in Case Management within two years of hire.
3. 3. Current American Heart Association BLS required.

Qualifications

Required

Behaviors

Thought Provoking

Capable of making others think deeply on a subject

Dedicated

Devoted to a task or purpose with loyalty or integrity

Team Player

Works well as a member of a group

Detail Oriented

Capable of carrying out a given task with all details necessary to get the task done well

Motivations

Required

Flexibility

Inspired to perform well when granted the ability to set your own schedule and goals

Ability to Make an Impact

Inspired to perform well by the ability to contribute to the success of a project or the organization

Equal Opportunity Employer
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