Case Manager - Social Worker

Kahuku Medical Center; Kahuku (HI); Presencial; USD 54 000 - 63 000; Tempo integral

Resumo da oferta

Kahuku Medical Center is seeking a Case Manager to coordinate admissions, discharge planning, and case management services. This role oversees patient vetting, registration, payer approvals, and referrals, acting as liaison among patients, families, and healthcare professionals to ensure continuity of care.

The position directs admissions activities, validates information, and coordinates with billing, pharmacy for medication review, and the provider for patient acceptance.

Qualificações

• Current Hawaii Social Work License required.
• Knowledge of insurance verification and healthcare regulations.
• Strong organizational, communication, and multitasking skills.
• Knowledge of community resources and critical thinking skills.
• Proficiency with electronic health records (EHR) systems.
• Five years of related hospital experience preferred.
• Master’s Degree in Social Work preferred.

Responsabilidades

• Coordinate admissions and discharge planning and respond to inquiries.
• Manage admissions per hospital procedures including pre-registration.
• Notify relevant departments of admissions and complete required reporting.
• Coordinate utilization management with Medical Director for reviews/appeals.
• Distribute NOMNC to Medicare patients and determine medical necessity.
• Provide case management and coordinate with patients, physicians and providers.
• Assess needs, arrange referrals (DME, home health, LTC, transport), follow-ups.
• Monitor progress and support informed decisions with agencies and families.
• Develop relationships with physicians and interdisciplinary team; uphold policies.
• Adhere to standards, policies, and regulatory requirements.
• Other duties as assigned by the Assistant Chief Nursing Officer.

Conhecimentos

Organizational skills

Communication skills

Multitasking

Insurance verification knowledge

Healthcare regulations knowledge

EHR proficiency

Community resources knowledge

Critical thinking

Formação académica

Master’s Degree in Social Work

Hawaii State Social Work License

Descrição da oferta de emprego

• Base Pay $39.62 - $45.71 / Hour
• Employee Type Non-Barg Non-Exempt FT

Contact information

• Name Human Resources
• Phone [phone]

Description

The Case Manager coordinates admissions, discharge planning, and case management services. This role oversees the patient vetting and registration process, including gathering and validating information, coordinating approvals with billing for payer source, pharmacy for medication review, and the provider for patient acceptance. The Case Manager also conducts initial and ongoing patient assessments, connects patients with appropriate resources , and makes referrals as needed. The role serves as a liaison among patients, families, and healthcare professionals to support clear communication and continuity of care.

ESSENTIAL FUNCTIONS:

Coordinate the admissions and discharge planning and respond to public and patient admission inquiries.

Manage admissions in line with the hospital's mission and procedures by collecting required information, obtaining approvals, and initiating pre-registration.

Notify relevant departments of admissions and complete required system reporting.

Coordinate utilization management, including inpatient reviews and appeals, through initial and ongoing clinical assessment, documentation, and interpretation of medical records in collaboration with the Medical Director.

Distribute and explain the Notice of Medicare Non-Coverage (NOMNC) to Medicare patients and evaluate acute patients to determine medical necessity and level of care.

Provide case management services and collaborate with patients, physicians, and other healthcare providers to support clinical, operational, and financial outcomes.

Assess patient needs, determine appropriate disposition, arrange referrals and coordinate services such as, durable medical equipment (DME), home health, long-term care, transportation, and follow-up appointments.

Monitor patient progress throughout the hospital stays, work with agencies and service providers, and support patients and families in making informed decisions.

Develop and maintain effective working relationships with physicians and interdisciplinary team members while supporting needed policies and procedures.

Adhere to professional standards, hospital policies and procedures, and applicable federal, state, and local requirements.

ADDITIONAL RESPONSIBILITES:

• Other duties as assigned by the Assistant Chief Nursing Officer.

JOB QUALIFICATIONS/EXPERIENCE/SKILLS:

REQUIRED:

Current state of Hawaii Social Work License.

Knowledge of insurance verification and healthcare regulations.

Strong organizational, communication, and multitasking skills.

Knowledge of community resources, and critical thinking skills.

Proficiency with electronic health records (EHR) systems.

PREFERRED:

• Five years of related experience in a hospital setting.
• Master’s Degree in Social Work.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Prolonged sitting with frequent standing, walking, occasional climbing or balancing, stooping, kneeling, crouching, and crawling.

Pushing, pulling, lifting, and carrying up to 10 lbs.

Potential exposure to infectious diseases, biohazards, and varying noise levels.

Working in a demanding environment.

Exposure to sensitive and confidential information.

DISCLAIMER:

This job description may not comprise all duties that may be required to be performed. Management reserves the right to amend as needed.