Case Manager ( RN / RT / SW / LPN )

Select Medical; Cincinnati (OH); On-site; USD 55,000 - 75,000; Full time

Job summary

A healthcare organization in Cincinnati is seeking a Case Manager responsible for overseeing utilization reviews, discharge planning, and resource management. Candidates should have current clinical licensure and experience in an inpatient setting. The role emphasizes coordinating with multidisciplinary teams and ensuring proper insurance reimbursement. Competitive salaries and a supportive work environment are part of the offer.

Qualifications

• Must have current licensure in a clinical discipline as a Nurse or a Respiratory Therapist.
• Previous experience in inpatient settings dealing with critical care patients is required.

Responsibilities

• Develop and implement discharge plans tailored to patients.
• Ensure compliance with utilization management policies.
• Build relationships with payors for proper reimbursement.

Skills

Clinical licensure

Critical care experience

Care management knowledge

Education

Nursing or Social Work license

Job description

Overview

At Select Specialty Hospital and Regency Hospitals, a division of Select Medical, we care for chronically and critically ill or post-ICU patients who require extended hospital care. Select Medical employs over 48,000 people across the country and provides quality care to approximately 70,000 patients each and every day across our four divisions.

Our mission is to provide an exceptional patient care experience that promotes healing and recovery in a compassionate environment. Each employee plays a vital role in doing that by living our cultural behaviors - celebrating success, owning the future, being patient-centered, creating change, thinking first and building trust.

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.

Responsibilities

• Develops and implements a patient specific, safe and timely discharge plan.
• Performs verification of utilization criteria reviews.
• Builds relationships and coordinates with payor sources to assure proper reimbursement for hospital provided services, promote cost-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.

Qualifications

• 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

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

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