Case Manager

UNC REX Healthcare; Old Farm (NC); On-site; USD 60,000 - 85,000; Full time

Job summary

UNC Lenoir Health Care in North Carolina seeks a Case Manager to coordinate hospital utilization review activities and discharge planning. You will complete CQI monitors and ensure compliance with Federal, State, and Third-Party guidelines while guiding patient education and community re-entry.

The role requires nursing or social work background with 3–4 years hospital, nursing home, or community-based experience, plus relevant certifications.

Qualifications

• Graduate from an accredited school of nursing or Medical Social Worker.
• Three to four years experience in hospital, nursing home, or community agency.
• Certification by American Board of QA/UR or InterQual; Social Work certification; NC RN/LPN license; Case Manager Certification within 5 years.

Responsibilities

• Monitors UR activities and reviews admission/continued stay for appropriateness.
• Obtain precertification to prevent payor denials and appeal when needed.
• Coordinate discharge planning and patient teaching with the care team.
• Document psychosocial, financial and educational needs; make referrals as needed.
• Coordinate continuity of care for transitions to nursing facilities or community re-entry.
• Serve as a resource person for families, staff, and physicians; participate in hospital committees.

Education

Graduate from accredited school of nursing

Baccalaureate Degree in Human Services area accepted

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 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 questione
• 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.

• Documenting psychosocial, financial, cultural, domestic violence and protective services situations. Refers if necessary.
• Develops plan to meet needs
• 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.

• Provides education and implementation of AMD and DNR, documents to patients as needed
• 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.

• Identifies appropriate level of care for nursing home placement/extended care
• Completes FL2, PASARR approval process
• 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.

• Assists with learning needs of staff
• Participates in job-related seminars and in service education
• Serves on hospital committees addressing managed care/length of stay
• Utilizes resources as appropriate
• Collaborates with other health care professionals in order to provide comprehensive quality care to patients and families.

6. Demonstrates Autonomy.

• Completes tasks as assigned
• Seeks and accepts additional job responsibilities and learning experiences
• Sets priorities according to patient needs
• Operates within parameters of hospital and department policies
• Demonstrates appropriate time management
• Seeks opportunities for professional growth
• Takes personal responsibility and initiative for performance and for professional growth and development.

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.
• • 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
    Obtain Case Manager Certification within 5 years.

Job Details

Legal Employer: Lenoir Health

Entity: UNC Lenoir Health Care

Organization Unit: Care Management

Work Type: Full Time

Standard Hours Per Week: 40.00

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.