Case Manager
Full Time – Day Variable Shift
Base Wage $36.97 to $69.95
Location: Cascade Valley Hospital

Job Summary
The position involves coordination of services to improve and maintain quality patient care and to ensure appropriate utilization of healthcare resources.

Serves as a liaison between the hospital, providers, and external payers on issues related to intensity of service and severity of illness for patients.

Ensures the timely and seamless transition of patients through medically appropriate levels of care.

Conducts patient status and medical necessity reviews at the time of hospital admission and also concurrently throughout the stay.

Reviews are documented in designated systems according to standard. In collaboration with physicians, promptly addresses documentation discrepancies.
Conducts and documents medical necessity reviews that demonstrate delivery of reasonable, necessary, and appropriate (according to evidence-based clinical standards of practice) patient care.

Collaborates with contracted resources for external medical necessity reviews and audits. Documents Changes of Status (COS) and completes supporting paperwork.

Performs readmission assessments utilizing indicated focus study.

Assists with insurance requests for clinical reviews and continued stay authorizations.

Provides physician education on medical necessity criteria.

Participates in medical necessity audits.

Assists with non-Medicare appeals research and preparation of written correspondence.

Facilitates Medicare discharge appeal process through contracted Quality Improvement Organization (QIO).

Participates in family care conferences as needed.

Captures potentially avoidable days (PADs) and documents in designated system.

Collaborates with physicians, nursing, social work, and other disciplines, departments, payers, and agencies to eliminate barriers to an efficient transition through the care continuum.

Collaborates with discharge planning team, and assists in the facilitation of discharges as needed.

Supports Population Health initiatives through patient outreach activities as assigned.

Adheres to regulatory agency guidelines/requirements governing patient notification (ie Important Message from Medicare, Medicare Outpatient Observation Notice, Hospital-Issued Notice of Non-coverage).

Education
BSN required unless a Certified Case Manager (CCM), or 2 years equivalent experience.

Experience/Training
Minimum three (3) years clinical practice experience required. Previous utilization review experience strongly desired. Experience using medical necessity screening criteria preferred.

License/Certifications
Current Washington State RN License required. Certified Case Manager (CCM) or Certified Professional in Healthcare Management (CPHM) preferred.

Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.

#INDRN

Job Type: Full-time

Pay: $36.97 - $69.95 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off

Schedule:

• Day shift

Work Location: In person