Case Manager

Orange County Naacp; Kinston (NC); Sur place; USD 60 000 - 80 000; Temps partiel

Résumé du poste

UNC Health in Kinston, NC seeks a Case Manager to coordinate utilization review, discharge planning, patient teaching, and community resource coordination. Responsibilities include monitoring medical necessity, completing chart reviews, and supporting interdisciplinary teamwork to ensure high-quality care and successful transitions to nursing facilities or community settings.

The role requires nursing or social work credentials, 3–4 years hospital or community-based experience, and CM

Qualifications

• Graduate from an accredited school of nursing (RN) or Medical Social Worker (MSW) required.
• Bachelor's degree in Human Services accepted.
• Case Manager Certification within 5 years.

Responsabilités

• Coordinate hospital utilization review activities and CQI monitoring.
• Coordinate discharge planning and patient/family education.
• Document psychosocial, financial, and protective services needs.
• Identify appropriate level of care for nursing home/extended care placements.
• Serve as a resource to families, staff, and community agencies.
• Promote patient teaching and autonomy in care decisions.

Connaissances

Case management

Discharge planning

Utilization review

InterQual criteria

Compliance

Formation

Nursing degree (RN)

Social work degree (MSW/LCSW)

Bachelor's in Human Services

Case Manager Certification within 5 years

Outils

InterQual criteria

Description du poste

# Case ManagerUNC HealthKinston, NCNov 03, 2026Healthcare Services## Job Description**Description**Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.Summary:* The Case Manager coordinates the hospital’s utilization review activities. Completes CQI Monitors for RM Committee and assures compliance with Federal, State and Third Party Insurance guidelines. Coordinates discharge planning, patient teaching and other associated activities for discharge to nursing facilities or successful community re-entry.Responsibilities:1. **Monitors UR activities/resource utilization**a. Reviews for appropriateness of admission and continued stayb. Obtains patient precertification to prevent possible payor denialsc. Appropriately follows through with Payor Denials with appeal processd. Confers with physician and/or refers to physician consultant when “Medical necessity” for admission or continued stay is questioned1. * Completes chart review within 24 working hours and obtains precertification within 48 working hours to appropriately monitor UR activities and prevent payor denials.2. **Interviews patients/families and records in Medical Record, Makes referrals.**2. 0. Documenting psychosocial, financial, cultural, domestic violence and protective services situations. Refers if necessary. 1. Develops plan to meet needs 2. Provides brief counseling services * Completes case findings, assessments, and treatment plans as per policy in order to provide effective intervention.3. **Coordinates/promotes patient teaching.**3. 0. Provides education and implementation of AMD and DNR, documents to patients as needed 1. Provides and identifies appropriate resources to meet educational needs of staff, patient, physician or community agency * Coordinates activities in conjuction with other multidisciplinary team members to meet educational needs.4. **Coordinates discharge planning between community agencies, interdisciplinary team, patients/families and physicians.**4. 0. Identifies appropriate level of care for nursing home placement/extended care 1. Completes FL2, PASARR approval process 2. Maintains working knowledge of financial and community resource regulations/availability * Coordinates continuity of care in order to facilitate transition from LMH.5. **Serves as a resource person for families, staff, community agencies and physicians.**5. 0. Assists with learning needs of staff 1. Participates in job-related seminars and in service education 2. Serves on hospital committees addressing managed care/length of stay 3. Utilizes resources as appropriate * Collaborates with other health care professionals in order to provide comprehensive quality care to patients and families.6. **Demonstrates Autonomy.**6. 0. Completes tasks as assigned 1. Seeks and accepts additional job responsibilities and learning experiences 2. Sets priorities according to patient needs 3. Operates within parameters of hospital and department policies 4. Demonstrates appropriate time management 5. Seeks opportunities for professional growth * Takes personal responsibility and initiative for performance and for professional growth and development.7. **Coordinates/promotes patient teaching.**7. 0. Promotes education and implementation of AMD and DNR, documents to patients as needed. 1. Provides and identifies appropriate resources to meet education needs of staff, patient, physician or community agency. * Coordinates activities to facilitate learning in accordance to needs assessment. * Includes patient/family and/or significant other in patient education plan.### Other information:* **EDUCATION**+ Graduate from an accredited school of nursing or Medical Social Worker. Baccalaureate Degree in Human Services area accepted. Obtain Case Manager Certification within 5 years.* **EXPERIENCE**+ Three to four years experience in hospital, nursing home, or community agency.* **LICENSURE/REGISTRATION/CERTIFICATION**+ Certification by American Board of QA/UR or InterQual, Certification in Social Work, Licensed in N.C. for RN or LPN* **OTHER SKILLS AND QUALIFICATIONS**Possess knowledge skills of InterQual ISD-A criteria. Good interpersonal and communication skills. Demonstrates understanding of patient care needs according to developmental stages for various age groups. Knowledge of State and Federal Regulations regarding admission/reimbursement of Medicare/Medicaid/all other payor sources. Reading and mathematics. Must be able to work autonomously### **Job Details**Legal Employer: Lenoir HealthEntity: UNC Lenoir Health CareOrganization Unit: Care ManagementWork Type: Per DiemStandard Hours Per Week: 4.00Work Assignment Type: OnsiteWork Schedule: Day JobLocation of Job: LENOIR MEMExempt From Overtime: Exempt: No Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.