Case Manager-1

Southeast. Always the right career direction. Job Description Summary The Utilization Review Nurse screens medical records in accordance with contractual agreement and regulatory requirements for medical necessity on admission and continued stay in the acute care setting. The UR case manager collaborates with all components of the healthcare system, managing appropriate use of acute care to aid in the achievement of quality outcomes, fiscal responsibility, and patient satisfaction. Job Description Essential Functions Perform admission and continued stay reviews of all inpatients and outpatient/observation patients in a bed; at times, this may be retrospective. Perform precertification on procedures ordered while patients are hospitalized. Issue required Medicare/Medicaid notifications of medical necessity changes to patients while hospitalized. Issue notifications of non-coverage letters to patients if received during hospital stay. Document clear billing notes into the EMR payer communications navigator to avoid billing denials. Perform medical necessity denial appeals. Maintain a close, collaborative relationship with the medical staff to promote continuity of care and avoid delays in service. Must demonstrate basic knowledge of discharge planning needs Direct Reports (positions supervised) None Qualifications Minimum Education Required Associates degree in Nursing Current RN license in the state Minimum Education Preferred Bachelor’s degree or higher in Nursing Minimum Experience Required Two (2) years acute care experience Must pass Blue Cross Blue Shield Iterator Reliability Test with 90% within six (6) months of hire Minimum Experience Preferred Three (3) years acute care experience One (1) year utilization review experience Required Skills/Abilities Demonstrates advanced computer skills (ability to generate reports, graph trends). Clinical knowledge and experience in the care of patients with multiple and complex diagnoses, disease process, and care needs. Ability to prioritize work and meet deadlines. Ability to problem solve in a proactive, creative manner, using sound judgment based on factual information and clinical knowledge. Ability to develop leadership skills and to serve as a role model for clinical staff. Ability to lead and actively participate in multidisciplinary teams. Ability to work independently within a team structure. Shift Day Shift Details 8:00 am - 4:30 pm FTE 1 Type Regular Join one of Forbes 500 best mid-sized employers in America. Equal Employment Employer Southeast Health is committed to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Southeast Health will provide reasonable accommodations for qualified individuals with disabilities. Let's connect! Submit your resume to connect with one of our recruiters. Watch this three-minute film showcasing our history, team members, community and future. Southeast Health is an academic community-based health system serving the healthcare needs of 460,000 residents in southeast Alabama, southwest Georgia, and the Florida panhandle. The organization includes, Southeast Health Medical Center, a 420-bed hospital with the region’s largest medical group and the Alabama College of Osteopathic Medicine (ACOM), the state’s largest medical school. The philanthropic arm of the organization is the Southeast Health Foundation, and its population health division is Southeast Health Statera Network. Southeast Health, a not-for-profit organization, exists to promote healing, prevent disease, educate medicine’s brightest minds, and bring wellness and prosperity to the region it serves. Delivering excellent patient care and top-notch educational experiences begins with great employees, which is why we constantly strive to improve the work experience for our 3,000 team members.