RN Case Manager or Social Worker Part-Time

Unity Physicians Hospital is a 29-bed surgical hospital that stands above other healthcare facilities due to the individualized attention we give to each and every patient we serve. We work as a team to maintain our 5-star rating in patient experience and recipients of the Best 100 Hospitals Women's Choice Award, because we are focused on patient satisfaction, we deliver better results and patients have better positive outcomes.

We are currently seeking an RN Case Manager or Social Worker/Part-Time/24 hrs. per week. The Case Manager provides health information, interacts, and acts as a resource for nursing units for complex clinical situations to ensure appropriate use of acute care services and diagnosis–related group (DRG) management. Assesses appropriateness of inpatient admissions and continued stay.

The Case Manager ascertains that charts are maintained for patients with appropriate documentation, orders, and procedures to appropriately give care for the patients. Provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, promoting continuity of care and cost effectiveness. Works with all members of the healthcare team to ensure compliance and continuity of care so the best possible patient outcomes are achieved.

Education: Graduate of accredited school of nursing. Registered Nurse license required. Bachelor’s degree strongly preferred.

Experience: One (1) year of case management and/or utilization review strongly preferred.

Licensure: Valid Registered Nurse license for the state in which the corporation resides. CPR certified within 180 days of hire.

Skills: Excellent verbal communication skills necessary to instruct and comfort patients and their families. Maintain effective contacts with a variety of hospital personnel and outside vendors to ascertain that appropriate patient care is always received. Must demonstrate knowledge and skills necessary to provide care appropriate to the age of the patient served on assigned unit/department. Computer literacy and mathematical ability to successfully perform the essential duties of this position. Ability to multi-task, work with numerous interruptions and willingness to assess and change priorities. Active Listening. i.e., giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

Responsibilities:

• Initial Assessments to identify discharge needs
• Social Determinant of Health Screenings, and provide appropriate resources
• Arrange appropriate outpatient/home base services for discharge
• Orders durable medical equipment (DME)
• Initial Precertification with payors.
• Concurrent Clinical review with payors.
• Consistently demonstrates professionalism with all internal and external customers as evidenced by the establishment and maintenance of productive working relationships.
• Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
• Seeks guidance and remains knowledgeable of, and complies with, all applicable federal and state laws, as well as hospital polices that apply.
• Complies with hospital expectations regarding ethical behavior and standards of conduct.
• Validates pre-authorization of commercial insurance for inpatients and for completing insurance reviews to ensure that all days are approved for the patient’s stay.
• Engages with insurances for reconsiderations, assists with appeals as needed, arrange peer to peer level reviews, and report the outcomes to the Director of Case Management and Team.
• Provides education to nursing staff, leadership team, and providers regarding documentation.
• Other duties as assigned

We offer a competitive compensation package, and a great work environment.

If you are interested in this opportunity and have the experience and job qualifications, please send your resume in confidence.

We look forward to hearing from you!

Job Type: Part-time

Benefits:

• Free parking
• Paid time off

Schedule:

• Monday to Friday
• Weekends as needed

Work Location: In person