Case Manager

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At Novant Health, one of our core values is diversity and inclusion. By engaging the strengths and talents of each team member, we ensure a strong organization capable of providing remarkable healthcare to our patients, families and communities. Therefore, we invite applicants from all group dynamics to apply to our exciting career opportunities.

East Cooper Medical Center is one of South Carolina's leaders in healthcare. Our approach to medicine is designed to provide patients with successful outcomes, fast recovery times, and a better quality of life. Our hospital combines technology and clinical expertise with compassion to provide personalized care for a lifetime. Our expanded scope of services, our commitment to quality & safety, and our outstanding team of caregivers have attracted patients throughout the Lowcountry and beyond, and have contributed to or hospital being nationally recognized. Interested in joining our team? Apply today!

Position Summary

Responsibilities

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:

• Utilization Management supporting medical necessity and denial prevention
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Education provided to physicians, patients, families and caregivers
  
  

The Individual’s Responsibilities Include The Following Activities

• accurate medical necessity screening and submission for Physician Advisor review
• care coordination
• transition planning assessment and reassessment
• implementation or oversight of implementation of the transition plan
• leading and facilitating multi-disciplinary patient care conferences
• managing concurrent disputes
• making appropriate referrals to other departments
• identifying and referring complex patients to Social Work Services
• communicating with patients and families about the plan of care
• collaborating with physicians, office staff and ancillary departments
• leading and facilitating Complex Case Review
• assuring patient education is completed to support post-acute needs
• timely complete and concise documentation in Case Management system
• maintenance of accurate patient demographic and insurance information
• identification and documentation of potentially avoidable days
• identification and reporting over and underutilization and other duties as assigned.
  
  

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Current license as a Registered Nurse in the State of South Carolina.
• BSN or MSN preferred.
• Minimum of three (3) years of hospital-based clinical experience preferred.
• Previous Case Management, Utilization Review or Discharge Planning experience desirable.
• Requires effective communication with patients, families, nursing, medical staff, and ancillary departments.
• Ability to take initiative to resolve problems immediately and implement change in a timely basis.
• Must be self-directed and able to adapt to change.
  
  

Novant Health is an equal opportunity employer and conducts all human resource practices in compliance with federal, state and local civil rights and employment legislation. Accordingly, Novant Health considers all applicants for employment equally, without regard to race, color, religion, sex, national origin, age, disability, veteran’s status, marital status, sexual orientation, gender identity or expression and provides them with an opportunity to progress in the organization consistent with their skills and interests.

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