Shift: 8:00AM - 5:00PM ET

Position Goal

The Case Manager is responsible for performing case management, utilization review, and discharge planning. This includes assessment, identification of specific patient needs, and social service intervention while in the hospital setting.

Position Responsibilities:

• Demonstrates knowledge of Case Management Department Policies.
• Conducts admission interview within twenty-four business hours of admission.
• Assesses, plans, implements, coordinates and evaluates health related service options throughout continuum of care.
• Reviews severity of illness and intensity of service indicators to assure that appropriateness of care criteria is met.
• Accesses community resources to meet the needs of the patient.
• Determines the needs of the patient.
• Documents reviews in the medical record and/or the computer system as appropriate.
• Completes data collection and activities as outlined by management.
• Documents required information consistent with Jack Hughston Memorial Hospital Case Management policies and procedures.
• Coordinates utilization review with Business Office/Revenue Cycle to ensure compliance, maximize reimbursement, monitors and coordinates issues related to audits.
• Performs admission, observation, concurrent and retrospective reviews to evaluate the medical necessity of hospital services during the patient’s stay.
• Coordinates the referral of cases to the Physician Advisor (PA) if not meeting approved criteria for admission or continued stay and distributes the Hospital Issued Notice of Non-coverage (HINN) when indicated.
• Conducts follow-up activities to ensure effectiveness of discharge planning.
• Communicates with payors and service providers in order to facilitate procurement of equipment and services required for discharge as ordered by the physician.
• Conducts individualized discharge planning activities for assigned patients and communicates the plan to involved participants.
• Participates in Patient Care Team Meetings.

Experience:

Preferred:

• 2-3 years case management experience in an acute setting preferred

Education:

Required:

• Bachelor's degree in Social Work or education required for RN license
• BLS certification through American Heart Association or American Red Cross

Special Qualifications:

Required:

• Current Alabama or Multi-State RN license in lieu of Bachelor's degree in Social Work
• Must be able to communicate effectively using both verbal and written communication skills
• Must be able to work independently and use sound judgment

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or protected veteran status.