MED SURG CASE MANAGER- FULL TIME

Summary/Objective:

Case management involves planning, implementing, coordinating, monitoring and evaluating the options and services available that will help meet patients needs. The overall aim is to help the patient return to a prior level of functioning if possible.

Essential Functions:

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

• Coordinates and facilitates patient care progression throughout the continuum of care.
• Works collaboratively with and maintains active communication with physicians, nursing staff and other members of the multi-disciplinary care team to effect timely, appropriate patient care.
• Utilization management supporting medical necessity and denial prevention.
• Request and obtain continued authorization during patients stay. Submit initial medical evaluations to external insurance providers within 24-72 hours of admission.
• Communicates authorizations through reports and treatment team physicians and other treatment staff.
• Serves as liaison between insurance companies, physicians and other clinical staff.
• Maintains current logs of denials and P2P.
• InterQual potential patients for admission.
• Obtain Med/Surg activity via Smart Sheet.
• Other duties as assigned

Competencies:

Communication proficiency

Ethical Conduct

Flexibility

Supervisory Responsibility:

This position has no supervisory responsibilities

Work Environment:

This job will require exposure to infectious and transmittable diseases while in patient contact. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, fax machines, and other equipment as needed.

Physical Demands:

The physical demands described as follows are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk and listen. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Duties regularly require standing, walking, bending, kneeling, stooping, pushing, pulling and crouching as well as lifting and/or moving up to 50 lbs.

Position Type/Expected Hours of Work

This is a full-time position, and core hours of work are Monday through Friday 8 hours per day with no overtime or with overtime as needed. Position requires work schedule flexibility based on the needs of the facility.

TRAVEL

Occasional travel may be expected for this position.

Required Education, Experience and License

High School Diploma

At least 2 years of experience in a hospital-based environment.

Experience in and current working knowledge of discharge planning.

Strong analytical skills.

Strong organization and time management skills, as evidenced by capacity to prioritize multiple tasks and roles. Ability to work independently and exercise sound judgment in interactions with physicians, staff, patient and their families.

Effective oral and written communication skills.

Preferred Education, Experience and License

Bachelors degree in healthcare

Additional Eligibility Qualifications

None

Work Authorization/Security Clearance (if applicable)

AAP/EEO Statement

Sweeny Community Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.