Case Manager ( RN / RT / SW / LPN )

Select Specialty Hospital; Augusta (GA); On-site; USD 52,000 - 76,000; Full time

Job summary

Select Specialty Hospital in Augusta, GA is seeking a Case Manager to oversee utilization reviews, discharge planning, and treatment plan management for chronically ill post-ICU patients. The role supports high-quality inpatient care and requires licensure in a clinical discipline or a Social Work license per state guidelines.

Responsibilities include coordinating with payors for proper reimbursement, ensuring accurate medical record documentation, and leading multidisciplinary team meetings

Qualifications

• Current licensure in a clinical discipline per state guidelines.
• Inpatient hospital experience in critical care preferred.
• Experience with discharge planning and utilization reviews preferred.

Responsibilities

• Develops patient-specific, safe and timely discharge plan.
• Performs verification of utilization criteria reviews.
• Coordinates with payor sources to maximize reimbursement.
• Demonstrates compliance with Utilization Management policies and procedures.
• Coordinates UR compliance with Quality Management to meet licensure/accreditation requirements.
• Maintains fiscal responsibilities and reviews insurance verification forms.
• Facilitates multi-disciplinary team meetings including physicians and nurses.

Skills

Discharge planning

Utilization reviews

Resource management

Collaboration

Communication

Education

RN/LPN/LVN license

Respiratory Therapist license

Social Work license

Job description

Select Specialty Hospital

Critical Illness Recovery Hospital (LTACH)

Case Manager

Full Time: Monday-Friday 8-5pm

Requires a current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN) or a Respiratory Therapist (RT) OR Medical Social Work (license per state guidelines).

Previous Discharge Planning Experience Preferred. Our hospital is a critical illness recovery hospital committed to providing world-class inpatient post-ICU services to chronic, critically ill patients who require extended healing and recovery. We help patients during some of the most vulnerable, painful moments of their lives - and our team plays a central role in providing compassionate, excellent care every step of the way.

We are looking for valued employees who will be Champions of the Select Medical Way, which includes putting the patient first, helping to improve quality of life for the community in which you live and work, continuing to develop and explore new ideas, providing high-quality care and doing well by doing what is right.

The Case Manager is responsible for utilization reviews and resource management, discharge planning, treatment plan management and financial management, while also completing medical record documentation. You will report directly to the Director of Case Management and provide social work services, as necessary, per state guidelines.

• Develops and implements a patient specific, safe and timely discharge plan.
• Performs verification of utilization criteria reviews.
• Builds relationships and coordinate with payor sources to assure proper reimbursement for hospital provided services, promote costs attentive care via focus on resource management within the plan of care.
• Demonstrates compliance with facility-wide Utilization Management policies and procedures.
• Coordinates UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
• Maintains fiscal responsibilities. Assures the department is identifying and negotiating the fullest possible reimbursement to maximize insurance benefit coverage for the patient. Reviews insurance verification forms to minimize risk.
• Facilitates multi-disciplinary team meetings including physicians, nurses, respiratory therapists and rehabilitation therapists.

We are seeking results-driven team players. Qualified candidates must be passionate about providing superior quality in all that they do.

Minimum Requirements

• Current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist (RN preferred) OR current license / certified Social Work license per state guidelines
• Previous RN/LPN/RT/SW/CM experience in an inpatient hospital setting dealing with critical care/acute care patients. (example: ICU, step-down, med surg, vents)

Preferred Qualifications That Will Make You Successful

• Specific experience in Care Management and Discharge Planning is preferred.
• Working knowledge of the insurance industry and government reimbursement.