Case Manager

UNC Health; Old Farm (NC); On-site; USD 52,000 - 70,000; Part time

Job summary

UNC Lenoir Health Care is seeking a Case Manager to coordinate hospital utilization review activities and discharge planning. Responsibilities include ensuring compliance with federal, state and third-party guidelines, and coordinating patient education for discharge to nursing facilities or community re-entry.

The role involves interdisciplinary collaboration, documentation of psychosocial needs, and promoting patient education on AMD and DNR.

Qualifications

• Graduate from an accredited school of nursing or medical social work.
• Bachelor's degree in Human Services is accepted.
• Certification as Case Manager within 5 years.

Responsibilities

• Monitor utilization review activities and assess admission/continued stay for medical necessity.
• Obtain precertifications and handle payor denials with appeals.
• Document psychosocial, financial, cultural, domestic violence and protective services needs; record in Medical Record.

Skills

InterQual ISD-A criteria

Interpersonal communication

Autonomy

Education

Nursing degree or MSW

Bachelor's degree in Human Services

Case Manager Certification within 5 years

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. 1. Monitors UR activities/resource utilization a. Reviews for appropriateness of admission and continued stay b. Obtains patient precertification to prevent possible payor denials c. Appropriately follows through with Payor Denials with appeal process d. Confers with physician and/or refers to physician consultant when “Medical necessity” for admission or continued stay is questioned Completes chart review within 24 working hours and obtains precertification within 48 working hours to appropriately monitor UR activities and prevent payor denials.
2. 2. Interviews patients/families and records in Medical Record, Makes referrals. Documenting psychosocial, financial, cultural, domestic violence and protective services situations. Refers if necessary.Develops plan to meet needsProvides brief counseling servicesCompletes case findings, assessments, and treatment plans as per policy in order to provide effective intervention.
3. 3. Coordinates/promotes patient teaching. Provides education and implementation of AMD and DNR, documents to patients as neededProvides and identifies appropriate resources to meet educational needs of staff, patient, physician or community agencyCoordinates activities in conjuction with other multidisciplinary team members to meet educational needs.
4. 4. Coordinates discharge planning between community agencies, interdisciplinary team, patients/families and physicians. Identifies appropriate level of care for nursing home placement/extended careCompletes FL2, PASARR approval processMaintains working knowledge of financial and community resource regulations/availabilityCoordinates continuity of care in order to facilitate transition from LMH.
5. 5. Serves as a resource person for families, staff, community agencies and physicians. Assists with learning needs of staffParticipates in job-related seminars and in service educationServes on hospital committees addressing managed care/length of stayUtilizes resources as appropriateCollaborates with other health care professionals in order to provide comprehensive quality care to patients and families.
6. 6. Demonstrates Autonomy. Completes tasks as assignedSeeks and accepts additional job responsibilities and learning experiencesSets priorities according to patient needsOperates within parameters of hospital and department policiesDemonstrates appropriate time managementSeeks opportunities for professional growthTakes personal responsibility and initiative for performance and for professional growth and development.
7. 7. Coordinates/promotes patient teaching. Promotes education and implementation of AMD and DNR, documents to patients as needed.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 Health

Entity: UNC Lenoir Health Care

Organization Unit: Care Management

Work Type: Per Diem

Standard Hours Per Week: 4.00

Work Assignment Type: Onsite

Work Schedule: Day

Job Location of Job: LENOIR MEM

Exempt 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.

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