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Case Management/Utilization Review

Job Summary

Responsible for the coordination and implementation of case management strategies pursuant to the Case Management Plan. Plans and coordinates care of the patient from pre-hospitalization through discharge. Responsible for authorization of appropriate services for continued stay and through discharge. Participates in performance improvement activities.

Full Time

All Clinical Careers

Demonstrates Competency in the Following Areas

• Able to communicate with physician regarding discharge planning needs of the patient. Assists the physician to facilitate post-hospital care.

• Is knowledgeable in locating the criteria for Medicare, Medicaid, and private insurance health care coverage.

• Reviews care and treatment for appropriateness against screening criteria and for infection prevention and control, quality and risk assessment; documenting same in computerized database.

• Actively participates and reports in Utilization Management Committee, Quality Council, and other meetings as applicable.

• Consults and works with health care team, as appropriate, to collaborate in patient care.

• Collaborates with other departments to identify operational problems and develop solutions/resolution.

• Meets with and patient and family to assist with disease management plan and discharge planning.

• Educates patient and family on all aspects of patient’s hospitalization, following the healthcare plan and continuing care.

• Responsible for authorization of appropriate services for continued stay and through discharge.

• Orders and arranges for home care equipment, healthcare needs as necessary.

• Works with third party payers to validate need for patient care and home care environment needs.

• Reviews and coordinates the discharge planning function

• Demonstrates strong, accurate decision-making skills.

• Participates in education on and implementation of clinical guidelines and protocols.

• Functions as a patient/family advocate ensuring each patient receives the most cost-effective care possible.

• Documentation meets current standards and policies.

• Demonstrates an ability to be flexible, organized and function under stressful situations.

• Supports and maintains a culture of safety and quality.

• Remains current on case management theory and practice, psychosocial issues current within the community and the healthcare environment.

Regulatory Requirements

• Bachelor of Science in Health Care related studies; degree in nursing preferred.
• Certification in Case Management preferred.
• Two or more years case management experience.

 

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Why Crescent regional Hospital?

At Crescent Regional Hospital, our goal is, and always has been, to cultivate a community of doctors, nurses, and administrators to breathe new life into a previously dying hospital as to provide a continuum of care for the communities of Lancaster, DeSoto, and all surrounding areas.  Unwavering in our vision and determined to not just be a choice in healthcare, but the choice in healthcare we need to hire the best from the community as to give the best care for the community.

Being of relative size to the communities we serve, both in staff and structure, allows us the ability to collaborate with and learn from one another as a means to provide treatment which is extensive, thorough, and specific to each patient. And because our internal culture is one of recognizing individual strengths and accomplishments, everyone gets their deserved moment to shine. As members of the Crescent Regional Family, we build one another up because we understand when we strive, our patients and community thrive which perpetuates us all into excellence.

 

We thank you for your interest in seeking employment with Crescent Regional Hospital and look forward to working with you when you become part of the Crescent Regional Family!