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Case Manager

Part-time

UNC Health Care

Kinston, NCPart-timePosted 3mo agoSeen in employer's feed 3 days ago

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At a glance

Compensation
No compensation found
Location
Kinston, NC
Schedule
Part-time
Work Authorization
Not specified

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Requirements

Credentials this posting asks for.

Certification By American Board Of QA/UR Or InterQualCertification In Social WorkLicensed In N.C. For RN Or LPNCase Manager Certification Within 5 YearsBachelor's degree

Job overview

UNC Health Care is hiring a Case Manager. The Case Manager coordinates utilization review activities, ensuring compliance with Federal, State, and Third-Party Insurance guidelines. This role involves discharge planning, patient teaching, and other associated activities for successful community re-entry or discharge to nursing facilities. The Case Manager also completes CQI Monitors for the RM Committee.

Key focus areas include Monitor UR activities and resource utilization, Review for appropriateness of admission and continued stay, and Obtain patient precertification to prevent payor denials.

Successful candidates bring Graduate From Accredited Nursing School, Three To Four Years Hospital Experience, and Certification By American Board Of QA/UR. Important skills include Utilization Review Activities, CQI Monitors, Compliance With Federal, State And Third Party Insurance Guidelines, Discharge Planning, Patient Teaching, and Appropriateness Of Admission And Continued Stay.

Skills & qualifications

RequiredNice to have

Skills

Utilization Review ActivitiesCQI MonitorsCompliance With Federal, State and Third Party Insurance GuidelinesDischarge PlanningPatient TeachingAppropriateness of Admission and Continued StayPatient PrecertificationPayor Denials Appeal ProcessMedical Necessity for Admission or Continued StayChart ReviewInterviewing Patients/FamiliesDocumenting Psychosocial, Financial, Cultural, Domestic Violence and Protective Services SituationsBrief Counseling ServicesCase FindingsAssessmentsTreatment PlansEducation and Implementation of AMD and DNRIdentifying Appropriate ResourcesCoordinating Activities With Multidisciplinary Team MembersIdentifying Appropriate Level of Care for Nursing Home Placement/Extended CareFL2PASARR Approval ProcessWorking Knowledge of Financial and Community Resource Regulations/AvailabilityContinuity of CareAssisting With Learning Needs of StaffParticipating in Job-Related Seminars and in Service EducationServing on Hospital CommitteesUtilizing ResourcesCollaborating With Other Health Care ProfessionalsCompleting Tasks as AssignedSetting Priorities According to Patient NeedsOperating Within Parameters of Hospital and Department PoliciesTime ManagementProfessional GrowthPersonal Responsibility and Initiative

Qualifications

Graduate From an Accredited School of Nursing or Medical Social WorkerBaccalaureate Degree in Human Services Area3-4 Years Experience in Hospital, Nursing Home, or Community AgencyCertification by American Board of QA/UR or InterQualCertification in Social WorkLicensed in N.C. For RN or LPNCase Manager Certification Within 5 Years

Full job description

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary:

  • The Case Manager coordinates the hospital’s utilization review activities. Completes CQI Monitors for RM Committee and assures compliance with Federal, State and Third Party Insurance guidelines. Coordinates discharge planning, patient teaching and other associated activities for discharge to nursing facilities or successful community re-entry

Responsibilities:

    1. Monitors UR activities/resource utilization a. Reviews for appropriateness of admission and continued stayb. Obtains patient precertification to prevent possible payor denialsc. Appropriately follows through with Payor Denials with appeal processd. Confers with physician and/or refers to physician consultant when “Medical necessity” for admission or continued stay is questioned

  2. Completes chart review within 24 working hours and obtains precertification within 48 working hours to appropriately monitor UR activities and prevent payor denials.2. Interviews patients/families and records in Medical Record, Makes referrals.

  4. Documenting psychosocial, financial, cultural, domestic violence and protective services situations. Refers if necessary.

  5. Develops plan to meet needs

  6. Provides brief counseling services

  7. Completes case findings, assessments, and treatment plans as per policy in order to provide effective intervention.3. Coordinates/promotes patient teaching.

  9. Provides education and implementation of AMD and DNR, documents to patients as needed

  10. Provides and identifies appropriate resources to meet educational needs of staff, patient, physician or community agency

  11. Coordinates activities in conjuction with other multidisciplinary team members to meet educational needs.4. Coordinates discharge planning between community agencies, interdisciplinary team, patients/families and physicians.

  13. Identifies appropriate level of care for nursing home placement/extended care

  14. Completes FL2, PASARR approval process

  15. Maintains working knowledge of financial and community resource regulations/availability

  16. Coordinates continuity of care in order to facilitate transition from LMH.5. Serves as a resource person for families, staff, community agencies and physicians.

  18. Assists with learning needs of staff

  19. Participates in job-related seminars and in service education

  20. Serves on hospital committees addressing managed care/length of stay

  21. Utilizes resources as appropriate

  22. Collaborates with other health care professionals in order to provide comprehensive quality care to patients and families.6. Demonstrates Autonomy.

  24. Completes tasks as assigned

  25. Seeks and accepts additional job responsibilities and learning experiences

  26. Sets priorities according to patient needs

  27. Operates within parameters of hospital and department policies

  28. Demonstrates appropriate time management

  29. Seeks opportunities for professional growth

  30. Takes personal responsibility and initiative for performance and for professional growth and development.7. Coordinates/promotes patient teaching.

  32. Promotes education and implementation of AMD and DNR, documents to patients as needed.

  33. Provides and identifies appropriate resources to meet education needs of staff, patient, physician or community agency.

  34. Coordinates activities to facilitate learning in accordance to needs assessment.

  35. Includes patient/family and/or significant other in patient education plan.

Other information:

  • EDUCATION

  • Graduate from an accredited school of nursing or Medical Social Worker. Baccalaureate Degree in Human Services area accepted.

  • EXPERIENCE

  • Three to four years experience in hospital, nursing home, or community agency.

  • LICENSURE/REGISTRATION/CERTIFICATION

  • Certification by American Board of QA/UR or InterQual, Certification in Social Work, Licensed in N.C. for RN or LPNObtain Case Manager Certification within 5 years.

Job Details

Legal Employer: Lenoir Health

Entity: UNC Lenoir Health Care

Organization Unit: Care Management

Work Type: Per Diem

Standard Hours Per Week: 4.00

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: LENOIR MEM

Exempt From Overtime: Exempt: No

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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