Case Manager New! Case Management | PRN | Phoenix ...Read More Quick Apply! Case Management Typ[...]

Phoenix Children's Hospital, Inc.; Phoenix (AZ); On-site; USD 60,000 - 80,000; Full time

Job summary

Phoenix Children's Hospital, Inc. is seeking a Case Manager to provide comprehensive care coordination and discharge planning. This role requires a Bachelor's in Nursing or equivalent experience and offers the opportunity to manage patient care effectively.

The ideal candidate will have at least 1 year of clinical experience in case management or discharge planning. Responsibilities include coordinating care, developing discharge plans, and ensuring optimal patient outcomes.

Qualifications

• Minimum of 1 year of broad clinical experience, with preference for case management, discharge planning, and utilization review experience.
• Working knowledge of third-party payer financial aspects and reimbursement.
• Use of evidence-based guidelines to manage LOS.

Responsibilities

• Coordinate care for a defined service line patient population, establishing estimated LOS via MCG criteria.
• Develop and implement comprehensive discharge care plans.
• Monitor day-to-day patient status, anticipating potential barriers to discharge.

Skills

Critical thinking to anticipate discharge needs

Excellent verbal and written communication

Computer skills: moderate to expert

Bilingual (Spanish)

MCG criteria knowledge

Education

Bachelor’s degree in Nursing or Associate degree in Nursing plus 3 years of clinical experience

Master’s degree in Nursing

Job description

Shift: Mon‑Fri, Sat, Sun (Days vary), 8 am‑5 pm.

Category: Nursing

Posting #: 987048

Employee Type: PRN

Position Summary

The Case Manager provides comprehensive care coordination and discharge planning for assigned patients, managing length of stay (LOS) and utilizing resources to ensure optimal outcomes. The role functions independently, under supervision from leadership, and is accountable for the quality of clinical services delivered by the case management team and community partners.

Position Duties

• Coordinate care for a defined service line patient population, establishing estimated LOS via MCG criteria and tools, and completing initial screenings within 24 hours of admission.
• Develop and implement comprehensive discharge care plans in collaboration with the interdisciplinary clinical team, ensuring clear documentation and addressing post‑discharge needs.
• Monitor day‑to‑day patient status, anticipating potential barriers to discharge, and escalating unresolved issues to Case Management, Manager, or Utilization Management Medical Director per department protocols.
• Review and analyze third‑party payer denials, communicating findings to the relevant team members, and participating in denial appeals or resolution processes.
• Maintain accurate, up‑to‑date discharge information in the case manager EMR system, updating documentation daily as patient needs evolve.
• Attend interdisciplinary and service line rounds, contributing to collaborative decision‑making and ensuring continuity of care.
• Provide concise, timely communication (e.g., responding to emails within 24 hours) and serve as a central point of information for the unit and team.
• Perform miscellaneous duties as requested by leadership.

Regulatory Responsibilities

• Daily review of patient status (Observation and Inpatient) for admission or discharge criteria compliance.
• Obtain and review necessary medical reports and treatment plans to support ongoing care and discharge planning.
• Apply MCG guidelines/pathways to determine admission status, level of care, and goal LOS, documenting findings in EMR.
• Record avoidable days, extended LOS, authorizations, and denials for medical necessity in SCM and SAM.
• Communicate data supporting denial appeals and potential denials to Utilization Management Nurse and payers.
• Maintain knowledge of DRG payment methodology and ICD‑9/10 coding.
• Provide Medicare/Tricare rights and detailed notice of discharge to patients and families.

Transition & Discharge Planning

• Develop early, thorough transition and discharge plans in collaboration with patients, families, payers, and providers.
• Assess appropriate discharge placements on admission and consult social services as needed.
• Communicate plans and potential issues to other case managers during transitions, ensuring clear, attainable goals.
• Validate patient and family understanding of the discharge plan through documentation and feedback.
• Educate families and patients to support a smooth transition, providing necessary training promptly.
• Coordinate outpatient and clinic care as patients move between inpatient and outpatient services.
• Respond to emails within 24 hours; demonstrate clear, effective communication with all customers.

Position Qualifications

Education

• Bachelor’s degree in Nursing or Associate degree in Nursing plus 3 years of clinical experience (required).
• Master’s degree in Nursing (preferred).

Experience

• Minimum of 1 year of broad clinical experience, with preference for case management, discharge planning, and utilization review experience (required).
• Working knowledge of third‑party payer financial aspects and reimbursement (preferred).
• Use of evidence‑based guidelines to manage LOS (preferred).

Special Skills

• Bilingual (Spanish) – preferred.
• MCG criteria knowledge – preferred.
• Excellent verbal and written communication – required.
• Critical thinking to anticipate discharge needs – required.
• Computer skills: moderate to expert – required.
• Decision‑making, problem‑solving, creative solution design, and influential leadership – required.

Additional Requirements

• Current Arizona RN license (required).
• Case Management Certification (CCM) – preferred.
• BLS certification for healthcare provider from the American Heart Association (required).
• Arizona Department of Public Safety Fingerprint Clearance Card (required).
• Compact State RN License (required).

Physical & Occupational Requirements

• Fine motor skills, hearing, pushing/pulling, reaching, sitting, standing, stooping/crouching, talking, walking, near/far vision, keyboard/mouse use – varying in frequency as listed.
• Lift up to 35 pounds without assistance – occasionally.
• Occupational exposure to office environment, airborne communicable diseases, and bloodborne pathogens – applicable.