Case Manager

What you'll be doing: Applies approved utilization criteria to monitor admissions, level of care, resource utilization and written communication to payers to ensure certification/authorization for inpatient and post acute services. Facilitates payor/physician contact when indicated for concurrent denial management processes. Identifies and plans strategies to reduce length of stay and resource consumption within the care management population. Coordinates and facilitates patient progression throughout the continuum of care. Refers cases and issues to the appropriate channels to elicit assistance to overcome medical management barriers. Facilitates communication with payors and external case managers and assists physicians, care providers, and patient/family in understanding payor plans and benefits. Participates in discharge planning is in place following a needs assessment and determining the appropriate goals for discharge for those patients requiring case managmenet. Works closely with social worker and other health care providers to initiate and facilitate referrals for home health care, hospice, other care facilities, durable medical equipment and supplies. Performs utilization management and monitors appropriate resource utilization, continued stay authorization. Communicates to resolve authorization issues, identifies potential denial issues, and facilitates discharge planning as provided by the payor.

What your background should be: 1-3 years acute care clinical experience required. 1-2 years case management experience or quality or utilization management preferred. Critical thinking, advanced communication, negotiation and collaboration skills. Computer skills, organization/time management, and prioritization skills.

Who is the client company: Concern about healthcare services.; If you are interested in this position, send your resume to apply@kochdavis.com