Job Description

The Case Manager assumes primary responsibility for documentation of appropriate medical necessity for the inpatient status or placement in observation. Communicates with physician, ancillary staff, and payers, and assists in arranging transfers or alternate placement when indicated. Assures proper level of care assignment. Collaborates and coordinates with other allied health professionals to ensure quality care is provided and desired outcomes are achieved in a timely and cost-effective manner. Utilizes a complete and systematic methodology/process to assess, plan, implement, evaluate and provide patient care coordination from pre-hospital through post-hospital care. Assists in the development of physician profiles to identify over/under utilization patterns. Promotes appropriate post-hospital utilization of resources. Ensures adequate education of patient and hospital staff. Works to reduce incidents of re-admissions. Supports hospital goals and objectives. Works within regulatory compliance guidelines. The Case Manager works collaboratively with all healthcare disciplines to assure appropriate and timely services. Assesses the medical appropriateness, quality, and cost-effectiveness of proposed hospital, medical, and surgical services. Collaborates with the interdisciplinary team to assist patient with benefits management. Evaluates appropriateness of the level of care. Communicates with payers to obtain authorization. Identifies and plans strategies to reduce inpatient length of stay and resource utilization.



Qualifications

State of Arizona RN license in good standing

Bachelor’s degree, preferred

1 - 3 years experience preferred

BLS required
Ability to work competently with computer based charting and other clinical and nonclinical software programs
Adaptability to change, good organizational skills
Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance companies and coverage details
Ability to advocate for patients
Ability to operate office equipment
Critical thinking skills
Ability to effectively interact with insurance companies and communities healthcare recourses

Ability to work what is sometimes a stressful, fast passed environment

Ability to speak/write English language fluently

 

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

 

Application Instructions

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