Case Manager ( RN / RT / SW / LPN )

Select Specialty Hospital; Madison (WI); On-site; USD 60,000 - 80,000; Full time

Job summary

A critical illness recovery hospital in Madison, WI is seeking a Case Manager. This full-time role focuses on utilization reviews, resource management, and discharge planning of critically ill patients. Candidates should have licensure as a Nurse, Respiratory Therapist, or Social Worker and previous experience in a hospital setting. Preferred qualifications include experience in Care Management and knowledge of the insurance industry. Join a team committed to providing compassionate care during vulnerable times.

Qualifications

• Current licensure in a clinical discipline: Nurse, Respiratory Therapist, or Social Work license.
• Previous experience dealing with acute care patients.
• Specific experience in Care Management and Discharge Planning is preferred.

Responsibilities

• Responsible for utilization reviews, discharge planning, and financial management.
• Develop and implement a patient-specific discharge plan.
• Coordinate UR compliance with Quality Management.

Skills

Discharge Planning

Resource Management

Patient Care

Utilization Management

Education

Current licensure in a clinical discipline (Nurse or Respiratory Therapist)

Social Work license per state guidelines

Job description

Position Summary

Full Time: Monday‑Friday 8‑5pm. Requires current licensure in a clinical discipline: Nurse (RN/LPN/LVN) or 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.

Responsibilities

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.

• Develop and implement a patient‑specific, safe and timely discharge plan.
• Perform verification of utilization criteria reviews.
• Build relationships and coordinate 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.
• Demonstrate compliance with facility‑wide Utilization Management policies and procedures.
• Coordinate UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
• Maintain fiscal responsibilities; ensure the department identifies and negotiates the fullest possible reimbursement to maximize insurance benefit coverage for the patient. Review insurance verification forms to minimize risk.
• Facilitate 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: Nurse or Respiratory Therapist (RN preferred) or 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 (e.g., 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.