Case Manager II

UNC Health Care; Woodridge (NC); On-site; USD 70,000 - 90,000; Full time

Job summary

Nash UNC Health Care in North Carolina is seeking a Registered Nurse Case Manager to coordinate utilization review and discharge planning within the NGH Case Management team.

This role focuses on collaborating with the Interdisciplinary Patient Care Team to ensure high-quality, cost-efficient care across Nash, Edgecombe, Halifax, Wilson Counties.

The position is full-time, onsite with 40 hours per week; RN license in NC required and 2-4 years hospital case management experience preferred.

Qualifications

• RN licensure in North Carolina required.
• 2–4 years of hospital case management experience.
• Bachelor's degree preferred.

Responsibilities

• Assess cases to determine the most effective and cost-efficient care model.
• Perform concurrent and retrospective reviews for private insurers, Medicare, and Medicaid.
• Determine frequency of patient reassessments and support nursing staff.
• Identify high-risk patients and report potential savings or denials.
• Coordinate discharge planning and post-discharge placements.

Skills

Case management

RN background

Education

Associate's Degree in Nursing

Bachelor of Nursing Degree

Job description

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

UNC Health Nash, an affiliated member of the UNC Health system, invites passionate healthcare professionals to join our esteemed team. Governed locally, we proudly serve a diverse patient base, spanning Nash, Edgecombe, Halifax, Wilson Counties, and beyond. With a steadfast commitment to elevating community health through exceptional care, we prioritize excellence, compassion, and innovation, ensuring every individual receives the highest standard of support. Joining our team means becoming an integral part of our dedication to wellness, where we constantly strive to redefine excellence in healthcare through state-of-the-art facilities and pioneering programs. Join us in this transformative journey, where your contributions will make a lasting impact on our community's health and wellbeing.

Summary

Facilitates effective and cost-efficient care of patients through such case management functions as utilization review and discharge planning. May facilitate the execution of existing clinical pathways for may facilitate the implementation of new clinical pathways. May follow the patient through the continuum of care, or may concentrate on one aspect of case management, depending on the area assigned. In collaboration with the Interdisciplinary Patient Care Team, coordinates the implementation of the discharge plan when it calls for post-discharge home care or placement into nursing homes or rehabilitation facilities, or community services.

Responsibilities

1. Accesses cases to determine most effective and cost-efficient model for care. Reviews assigned patients' cases prior to, or upon admission, and determines most effective and cost-efficient model for care. Appropriately recommends eligibility for pathways, protocols, or guidelines that could improve patient care and utilization of resources.
2. Performs concurrent and retrospective admission and continued stay reviews for private insurance companies, Medicare and Medicaid, in accordance with utilization review guidelines. Tactfully and effectively informs Manager of physicians' impact days and constructively offers more cost-effective alternative approaches and/or recommendations to minimize reoccurrences.
3. Determines frequency of patient reassessments according to identified needs and input from RN and MD. Serves as a resource person for nursing staff related to psychosocial, mental health, and substance abuse patient care. Participates in the interdisciplinary plan of care. Collaborates with the nursing staff regarding patient / family education and discharge planning needs.
4. Identifies and reports problematic DRGs, extended stay patients, frequent readmissions or high-risk patients. Identifies and reports savings incurred through early discharges. Identifies and reports losses incurred due to extended stay and admission denials. Differentiates and reports internal, external, patient/family origin for delayed discharges.
5. Effectively serves as a patient/family resource and advocate in ensuring that their questions, concerns, and needs are addressed appropriately and in a timely manner. Effectively coordinates and documents the placement of patients into residential or rehabilitative settings, as needed, ensuring that administrative requirements are accurately and completely accomplished in accordance with procedure and time frames.

Education Requirements

• Graduation from an accredited college with an Associate's Degree in nursing.
• Bachelor of Nursing Degree is preferred.

Licensure/Certification Requirements

• Current license to practice as a RN in North Carolina

Professional Experience Requirements

• 2-4 years of Case Management hospital experience

Work Details

Legal Employer: Nash Hospitals

Entity: Nash UNC Health Care

Organization Unit: NGH Case Management

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: NASH HC

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.