Case Manager PRN

ScionHealth; Palestine (TX); On-site; USD 65,000 - 85,000; Full time

Job summary

ScionHealth in Texas seeks a Care Coordination professional to manage patient flow and plan care across the interdisciplinary team. You will collaborate with ICT, physicians, and case managers to ensure efficient service delivery and compliant care.

Responsibilities include performing comprehensive assessments, discharge planning, and utilization review. You will advocate for patients, coordinate resources, and refer high-risk cases while maintaining timely communication with payors and hospital

Qualifications

• Graduate of accredited nursing or social work program with licensure in the state.
• Licensure requirements depend on role and state regulations.
• Experience in case management, utilization review, or discharge planning a plus.

Responsibilities

• Coordinate clinical and psychosocial activities with the interdisciplinary team and physicians.
• Assist with effective care coordination and discharge planning.
• Refer high-risk patients for additional support as needed.
• Advocate for patients and collaborate with payors and hospital leadership.
• Conduct utilization management reviews from admission to discharge and ensure resource efficiency.

Skills

Care coordination

Interdisciplinary collaboration

Communication skills

English fluency

Analytical abilities

Microsoft Office

Education

RN or LPN licensure

MSW licensure

LCSW/LSW licensure (if required)

Job description

Description

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions

Care Coordination

• Assist in coordinating clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Assists with effective care coordination and efficient care facilitation.
• Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
• Appropriately refers high risk patients who would benefit from additional support.
• Serves as a patient advocate.
• Knowledgeable of the principles of growth and development over the life span and the skills necessary to provide age-appropriate care to the patient population served.
• Participates in interdisciplinary patient care rounds and/or conferences.
• Collaborates with clinical staff in the execution of the plan of care, and achievement of goals. Discharge Planning
• Under appropriate supervision, conducts comprehensive, ongoing assessment of patients and family to provide timely and safe discharge planning.
• Assists with comprehensive discharge planning. Utilizes critical thinking to execute effective discharge planning. Utilization Management
• Conducts medical necessity review for appropriate utilization of services from admission through discharge.
• Promotes effective and efficient utilization of clinical resources.
• Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.

Other

• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Serves on Hospital and Division committees when requested.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Must read, write and speak fluent English.
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers
• Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
• Must have regular attendance.
• Approximate percent of time required to travel, 0%.
• Performs other related duties as assigned.

Qualifications

Education

• Graduate of an accredited program required: LPN/LVN or RN.
• Master of Social Work with licensure as required by state regulations or Bachelor of Social Work with licensure as required by state regulations.

Licenses/Certifications

• Healthcare professional licensure required as LPN/LVN, Registered Nurse, or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.

Experience

• One year of experience in healthcare setting.
• Experience in case management, utilization review, or discharge planning a plus.