What are the responsibilities and job description for the Acute Care Case Manager - Emergency Medicine position at Grand View Hospital?
About the Role
We are seeking a skilled Acute Care Case Manager to join our team in the Department of Emergency Medicine at Grand View Hospital. This is a unique opportunity to make a meaningful impact on patient care and outcomes.
Responsibilities
- Review anticipated admissions utilizing InterQual criteria to assess for appropriate level of care assignment, ensuring efficient use of hospital resources.
- Certify Medicare admissions and utilize Code 44 when necessary, maintaining compliance with regulatory requirements.
- Coordinate and manage inpatient Medicare Discharge expedited appeal requests from the QIO and patients, resolving issues promptly.
- Serve as a valuable resource to patients, physicians, Administration, and hospital employees regarding issues related to patient classification and reimbursement, providing expert guidance.
- Refer inappropriate Observation or anticipated Admission cases to the Physician Advisor, facilitating informed decision-making.
- Implement strategies to decrease non-emergency utilization and over-utilization by patients in the DEM, promoting cost-effective care.
- Provide real-time interventions to prevent delays and ensure compliance and revenue integrity with healthcare regulations, optimizing patient outcomes.
- Collect and analyze data regarding resource utilization for DEM physicians, management, and administration, informing process improvements.
- Communicate new information regarding coordination of care, case management, managed care, and the continuum of care to the DEM, fostering collaboration.
Key Qualifications
- Masters of Social Work degree with 3-5 years of acute care case management experience.
- Active Social Work License in Pennsylvania (preferred).
What We Offer
- A competitive salary of $65,000-$85,000 per year, depending on experience.
- A comprehensive benefits package, including medical, dental, and vision insurance, starting on the 1st of the month after start date.
- Wellness and gym discounts, as well as free cardiac rehab gym access.
- 403B plan, on-site discounted childcare center, paid time off, sick time, tuition assistance, free life insurance for full-time employees, long-term disability for full-time employees, short-term disability, employee referral bonus, identity theft insurance, pet insurance, flexible spending accounts, employee discount program, and employee assistance program.
- Free parking.
Salary : $65,000 - $85,000
