Hospital Case Manager RN - Discharge & Care Coordination

Prisma Health; Columbia (SC); On-site; USD 65,000 - 95,000; Full time

Job summary

Prisma Health's Hospital Case Management department seeks a dedicated Hospital Case Manager to oversee case management for inpatients, coordinating discharge planning and ensuring efficient, cost-effective care in collaboration with physicians, payors, and the care team.

The role emphasizes utilization management, regulatory compliance, and timely communication with providers and families to optimize patient outcomes and resource use.

Qualifications

• Bachelor's degree in nursing is required.
• Three (3) years acute care nursing experience required; one (1) year acute case management experience preferred.

Responsibilities

• Participates in discharge planning activities to ensure timely discharge and linkage with post-acute care providers.
• Consults with interdisciplinary teams and leadership to resolve barriers in progression of care in hospitalization.
• Addresses and resolves system problems impeding diagnostic or treatment progress and monitors patient progress.
• Assesses patients’ psychosocial risk factors based on preliminary screening.
• Advocates for patient and family empowerment to access needed services within the health care system.
• Maintains knowledge of body systems and regulatory changes related to case management in acute care.
• Uses clinical guidelines for initial/admission and continued stay reviews to ensure medical necessity and appropriate level of care.
• Promotes efficient use of clinical resources and provides timely reviews to third party payors.
• Sets patient goals with patient/family and negotiates healthcare resources for care options throughout the continuum.
• Serves as a resource regarding rights and responsibilities when care is denied or no longer medically necessary.

Skills

Acute care nursing experience

Acute case management experience

Education

Bachelor's degree in nursing

Job description

Prisma Health's Hospital Case Management department seeks a dedicated Hospital Case Manager to oversee case management for inpatients, coordinating discharge planning and ensuring efficient, cost-effective care in collaboration with physicians, payors, and the care team.

The role emphasizes utilization management, regulatory compliance, and timely communication with providers and families to optimize patient outcomes and resource use.