Case Manager RN, LMSW Part Time

About the position

The Case Manager II Part Time position at Cornerstone Specialty Hospitals Conroe is dedicated to delivering excellence and an empathetic human experience to every patient, family member, and employee. This role is pivotal in coordinating and facilitating the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. The Case Manager will follow patients throughout the continuum of care, ensuring optimum utilization of resources, service delivery, and compliance with external review agencies. The position involves providing ongoing support and expertise through comprehensive assessment, care planning, plan implementation, and overall evaluation of individual patient needs. The ultimate goal is to enhance the quality of patient management and satisfaction, promoting continuity of care and cost-effectiveness through the integration of case management, utilization review, and discharge planning functions. In this role, the Case Manager will coordinate clinical and psycho-social activities with the Interdisciplinary Team and Physicians, monitor all areas of patients' stay for effective care coordination, and remain current on reimbursement modalities, community resources, and legal issues affecting patients and providers. The Case Manager will also serve as a patient advocate, enhancing collaborative relationships to maximize the patient's and family's ability to make informed decisions. Participation in interdisciplinary patient care rounds and conferences is essential to review treatment goals, optimize resource utilization, and provide family education. The Case Manager will also conduct comprehensive assessments for timely and safe discharge planning, ensuring effective communication with patients and families throughout the process. Additionally, the Case Manager will conduct medical necessity reviews for appropriate utilization of services from admission through discharge, promoting effective and efficient utilization of clinical resources. This role requires a strong understanding of government and non-government payor practices, Medicare benefits, and accreditation standards, ensuring compliance with all relevant regulations and standards.

Responsibilities
• Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
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• Monitors all areas of patients' stay for effective care coordination and efficient care facilitation.
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• Remains current regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
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• Appropriately refers high risk patients who would benefit from additional support.
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• Serves as a patient advocate, enhancing collaborative relationships to maximize the patient's and family's ability to make informed decisions.
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• Demonstrates knowledge of growth and development principles over the life span and provides age-appropriate care to the patient population served.
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• Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs.
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• Collaborates with clinical staff in the development and execution of the plan of care and achievement of goals.
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• Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in planning patients' care throughout the care continuum.
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• Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning.
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• Provides comprehensive discharge planning for each patient, utilizing critical thinking to develop and execute effective discharge planning.
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• Coordinates and communicates with patient/family efficiently and effectively.
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• Conducts medical necessity review for appropriate utilization of services from admission through discharge.
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• Promotes effective and efficient utilization of clinical resources.
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• Conducts timely and accurate clinical reviews, care collaboration, and coordination of continued stay authorization with payor.

Requirements
• Graduate of an accredited program required: RN, BSN preferred, or Master of Social Work with licensure as required by state regulations, or Bachelor of Social Work with licensure as required by state regulations.
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• Healthcare professional licensure required as Registered Nurse or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations.
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• Certification in Case Management preferred.
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• Two years of experience in a healthcare setting preferred.
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• Prior experience in case management, utilization review, or discharge planning is preferred.
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• Knowledge of government and non-government payor practices, regulations, standards, and reimbursement.
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• Knowledge of Medicare benefits and insurance processes and contracts.
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• Knowledge of accreditation standards and compliance requirements.

Nice-to-haves

Benefits

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