Case Manager – Utilization Management

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

📋 Description

• Supervise the patient care delivery process.

• Collaborate and provide leadership to the healthcare team.

• Review medical records for treatments and interventions to prevent payment denials and enhance reimbursement.

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

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

• Assess patients for discharge planning and the suitability of their level of care.

• Identify and assist in overcoming barriers to discharge.

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

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

• Meet with patients and families to evaluate needs and create personalized continuing care plans in collaboration with physicians.

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

• Communicate with Utilization Management, Case Management, and Physician Advisory teams regarding level-of-care decisions, reimbursement, and concurrent denials.

• Oversee patient flow during multidisciplinary rounds and implement strategies to reduce delays.

• Advocate for Emergency Department patients by recognizing needs and coordinating necessary services and resources.

• Ensure that critical care plan information is effectively communicated to patients, families, and healthcare team members.

• Carry out additional duties as requested by the Case Manager Supervisor and/or Director.

⛳️ Requirements

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

• Proficiency in data entry and computer skills is necessary.

• A valid Registered Nurse license/certification is mandatory.

• Capability to cover various patient populations across the organization, including the Emergency Department.

🏝️ Benefits

• Part-time schedule available.

• We are an equal opportunity employer.