RN Case Manager: Discharge & Utilization Lead

Universal Health Services; Aiken (SC); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Sign On Bonus

Referral Program

PTO and Benefits

Medical/Dental/Vision

Job summary

Universal Health Services is seeking a Case Manager (RN) at Aiken Regional Medical Centers in Aiken, SC to oversee admission reviews, continuity of care, and discharge planning. The role emphasizes collaboration with surgeons, nurses, social work, and payers to optimize patient flow and minimize denials.

Responsibilities include chart reviews for admission and stay, coordinating with the SW/DCP team, and helping prevent delays by proactive care management while ensuring safe transitions on the

Qualifications

• Diploma or associate degree from an accredited Registered Nursing program; BSN preferred.
• Minimum of 3 years experience in acute-care hospital or related setting; utilization review or case management experience.
• SC RN license or compact state license.

Responsibilities

• Performs admission, concurrent and retrospective chart reviews to certify appropriateness of admission, accurate status, continued stay and reduce denial risks.
• Follows department processes for management of denied cases and referrals for review or appeal.
• Monitors patients for progression of care and readiness for discharge; collaborates with SW/DCP for timely transitions.
• Performs discharge planning to ensure timely transition of care on the assigned unit.
• Collaborates with nursing and interdisciplinary team to anticipate discharges and communicates with clinical staff.
• Maintains relationships with insurance companies to obtain payment authorization and manage denials while patients are in-house.
• Documents and justifies admissions/continued stay to support medical necessity.
• Identifies avoidable hospital days and initiates interventions to minimize delays.
• Educates medical staff on utilization of hospital days and resources; makes referrals to Infection Control, Wound Care, Nutrition, and Peer Review as needed.
• Contributes to development of clinical practice guidelines for designated patient groups.

Skills

Private insurance knowledge

Medicare criteria knowledge

Healthcare financial systems

Benchmarking practices

Interdisciplinary collaboration

Computer skills

Education

RN Diploma or Associate degree

BSN preferred

Job description

Universal Health Services is seeking a Case Manager (RN) at Aiken Regional Medical Centers in Aiken, SC to oversee admission reviews, continuity of care, and discharge planning. The role emphasizes collaboration with surgeons, nurses, social work, and payers to optimize patient flow and minimize denials.

Responsibilities include chart reviews for admission and stay, coordinating with the SW/DCP team, and helping prevent delays by proactive care management while ensuring safe transitions on the