Case Manager – Utilization Management

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

📋 Description

• Supervise the delivery of care provided to patients.

• Collaborate and lead the healthcare team effectively.

• Review medical treatment records and interventions to prevent payment denial and maximize reimbursement opportunities.

• Evaluate the appropriateness of treatments, their effectiveness, timing, and settings.

• Decide between observation and inpatient levels of care based on medical necessity.

• Assess patients for discharge planning and the appropriateness of their care levels.

• Identify and assist in minimizing barriers to discharge.

• Coordinate and facilitate the progression of patient care across the continuum.

• Ensure that care plans and services are focused on the patient, high in quality, efficient, and cost-effective.

• 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 action for ongoing improvement.

• Communicate with Utilization Management and Case Management teams regarding level-of-care decisions and reimbursement matters.

• Collaborate with the Physician Advisory team on concurrent denial cases.

• Track patient flow during multidisciplinary rounds and assist in implementing process enhancements.

• Advocate for patients in the Emergency Department by identifying their needs and coordinating necessary services and resources.

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

• Serve various patient populations, including those in the Emergency Department.

• Perform additional duties 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 is required.

• Proficiency in data entry and computer skills is required.

• A valid Registered Nurse license/certification is mandatory.

🏝️ Benefits

• Comprehensive health benefits package.

• Opportunities for professional development and continuing education.

• Supportive work environment with a focus on teamwork.

• Competitive salary and performance incentives.