Case Manager – Utilization Management

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Supervise the care delivery process to patients and lead the healthcare team effectively.

• Review medical records, treatments, interventions, and care levels to ensure medical necessity and optimize reimbursement.

• Coordinate and facilitate the progression of patient care throughout the entire continuum.

• Ensure that care plans and services are centered around the patient, maintaining high quality, efficiency, and cost-effectiveness.

• Engage with patients and families to evaluate needs and create personalized continuing care plans alongside physicians.

• Monitor length of stay and the use of ancillary resources, taking proactive steps for ongoing improvement.

• Collaborate with Utilization Management and Case Management teams regarding level-of-care decisions and reimbursement processes.

• Partner with the Physician Advisory team to address concurrent denials and ensure the appropriate level of care before billing.

• Oversee patient flow during multidisciplinary rounds and implement process enhancements to minimize delays.

• Act as an advocate for Emergency Department patients by identifying their needs and coordinating necessary services and resources.

• Relay plan-of-care components to patients, families, and healthcare team members effectively.

• Support various patient populations throughout the organization, including those in the Emergency Department.

• Carry out additional responsibilities as assigned by the Case Manager Supervisor and/or Director.

⛳️ Requirements

• A minimum of 1-2 years of recent experience in an acute care hospital setting is required.

• Proficiency in data entry and computer skills is essential.

• A valid Registered Nurse license/certification is mandatory.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and advancement.

• Supportive work environment with a focus on teamwork and collaboration.