Case Manager ( RN / RT / SW / LPN )

Select Specialty Hospital San Antonio Inc.; Plano (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Select Specialty Hospital is seeking a Case Manager at its Critical Illness Recovery Hospital (LTACH) to oversee discharge planning, utilization reviews and treatment plan management. This full-time role reports to the Director of Case Management and involves maintaining medical record documentation and coordinating with payors.

This position requires active licensure in a clinical discipline (RN/LPN/LVN or RT) or a Social Work license per state guidelines, with prior inpatient hospital

Qualifications

• 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.
• Experience in inpatient hospital settings with critical care/acute care patients (ICU, step-down, med surg, vents) is desirable.

Responsibilities

• Develops patient-specific discharge plans.
• Performs verification of utilization criteria reviews.
• Coordinates with payor sources to ensure proper reimbursement.
• Ensures compliance with Utilization Management policies and procedures.
• Facilitates UR coordination with Quality Management for licensure/accreditation.
• Maintains fiscal responsibilities and maximizes insurance coverage.
• Leads multi-disciplinary team meetings with physicians, nurses, RTs and rehabilitation therapists.

Skills

Case management

Utilization review

Discharge planning

Interdisciplinary collaboration

Education

RN

LPN/LVN

Respiratory Therapist (RT)

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.