Responsibilities Case Management(RN) - Fulltime
Aiken Regional Medical Centers, located in Aiken, South Carolina, is a 273-bed acute care facility providing quality healthcare to the residents of Aiken and surrounding communities. Aiken Regional Medical Centers has been ranked a top hospital in South Carolina by the Carolina Center for Medical Excellence for its treatment of heart attack, heart failure and pneumonia. Services provided at the hospital include emergency medical care, orthopedic surgeries, maternity, and behavioral health services.
Visit us online at: https://www.aikenregional.com
The Case Manager is responsible for admission, concurrent and retrospective medical review of all patient populations for documentation of appropriateness of admission and continued stay. This position requires close collaboration and communication with payers to reduce risk of denials by continued management of all assigned cases from admission to discharge. Responsible for managing assigned patient population for progression of medical management and readiness for discharge. This includes the initiation of interventions to reduce and eliminate avoidable days, opportunity days and delays in care; works in collaboration with interdisciplinary team members internal and external to the organization; participates in process improvement and evaluation process related to the management of patient care and resource utilization. Responsible for working in close collaboration with the assigned SW/DCP on the floor to ensure a safe and timely transition of care, with the goal of management of LOS and utilization of resources on their assigned units. Performs discharge planning as needed to ensure timely transition of care of all patients on the assigned unit.
Duties:
- Performs chart reviews (admission, concurrent and retrospective, as necessary) for all payor sources in order to certify appropriateness of admission, accurate status, continued stay and reduce denial risks.
- Follows department processes for management of denied cases, refers these cases for Peer to Peer or for VH appeal. Sends updated clinical to request reconsideration when appropriate.
- Follows department process for referrals to VERSALUS HEALTH for all OBS cases and follows up after review to facilitate order status changes as appropriate.
- Monitors all patients on their assigned floor for progression of care and clinical readiness for discharge and works with their SW/DCP partner to limit delays in transition of care by performing discharge planning as needed in the assigned unit.
- Works in collaboration with partner, nursing, and other members of the Interdisciplinary team to anticipate discharges for the next day and provides this information to clinical staff at the end of each day.
- Maintain strong relationship with insurance companies to share clinical information for payment authorization and limit risk of denials. Follows and continues to work denied cases in an effort to overturn denials while patients are still in house.
- Collaborates with members of the healthcare team to ensure documentation supports admission or continued stay when documentation is not clear to ensure appropriateness of acute hospital stay.
- Identifies and documents, and manages avoidable hospital days according to defined criteria and initiates appropriate intervention as necessary to minimize discharge delays.
- Educates medical staff, nursing and other members of the healthcare team regarding utilization of hospital days and resources.
- Identifies and makes referrals to other departments such as Infection Control, Wound Care, Nutrition/Dietary, and Peer Review as appropriate.
- Collaborates with Medical staff and other departments as appropriate to facilitate development of clinical practice guidelines for designated patient groups.
Benefit Highlights
- Tuition/Certification Reimbursement after 6 months
- Loan Forgiveness Program
- Challenging and rewarding work environment
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- SoFi Student Loan Refinancing Program
- Career development opportunities within UHS and its 300+ Subsidiaries!
- More information is available on our Benefits Guest Website: uhsguest.com
Universal Health Services
One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com
Qualifications Requirements:
Education requirements: Diploma or associates degree from an accredited Registered Nursing program. BSN preferred.
Work experience requirements: Minimum of 3 years experience in acute-care hospital or related setting; previous utilization review or case management experience.
Required licenses/ certifications/courses SC RN license or compact state license.
Required skills, knowledge and abilities: Knowledge of private insurance, Medicare criteria for hospitalization, understanding of healthcare financial systems, benchmarking practices; Experience in facilitating change through interdisciplinary collaboration; computer skills.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
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