What are the responsibilities and job description for the Certified Case Manager - (Full-Time Monday-Friday) position at Washington Regional Medical System?
Organization Overview, Mission, Vision, and Values
Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We employ 3,400 team members and serve the region with over 45 clinic locations, the areas only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.
Position Summary
The role of the Case Manager Certified reports to the Director of Case Management and Social Services. This position is responsible for coordinating the admission case management process while collaborating with and external physician advisors regarding secondary medical reviews.
Essential Position Responsibilities
- Assist patients and their families with procurement of community resources, as needed
- Collaborate with internal and external clients to facilitate appropriate admission status
- Perform initial InterQual reviews, collaborate with admitting physicians and makes referral to secondary medical review physician advisors when indicated to determine the appropriate patient status
- Serve as an educator and resource for staff regarding InterQual and annual updates
- Serve on the Utilization Review Committee
Qualifications
- Education: Must be a graduate of an accredited nursing or social work program
- Licensure and Certifications: Registered Nurse License or Social Worker license and Certified Case Manager (CCM), required.
- Experience: Minimum of three years nursing experience, required. Previous knowledge of third-party payer guidelines regarding reimbursement as normally acquired through a minimum of one year of case management/UR experience, required. Previous experience with InterQual, required.
Work Environment: This position will 70% of time sitting while performing work in a standard office environment. This position will spend 30% of time standing and/or walking while pushing, pulling, lifting and/or carrying up to 50 lbs. This position will serve a culturally and linguistically diverse patient population. This position may be exposed to communicable diseases and bodily fluids.
