About this opportunity
UNC Health Care lists this Case Manager opportunity in kinston, North Carolina. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Description
nYour passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.
nSummary:
nnThe Case Manager coordinates the hospital’s utilization review activities. Completes CQI Monitors for RM Committee and assures compliance with Federal, State and Third Party Insurance guidelines. Coordinates discharge planning, patient teaching and other associated activities for discharge to nursing facilities or successful community re-entry
n nResponsibilities:
nnnnMonitors UR activities/resource utilization a. Reviews for appropriateness of admission and continued stayb. Obtains patient precertification to prevent possible payor denialsc. Appropriately follows through with Payor Denials with appeal processd. Confers with physician and/or refers to physician consultant when “Medical necessity” for admission or continued stay is questioned
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n nnnnCompletes chart review within 24 working hours and obtains precertification within 48 working hours to appropriately monitor UR activities and prevent payor denials.2. Interviews patients/families and records in Medical Record, Makes referrals.
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nnnDocumenting psychosocial, financial, cultural, domestic violence and protective services situations. Refers if necessary.
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nnDevelops plan to meet needs
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nnProvides brief counseling services
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nnCompletes case findings, assessments, and treatment plans as per policy in order to provide effective intervention.3. Coordinates/promotes patient teaching.
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nnnProvides education and implementation of AMD and DNR, documents to patients as needed
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nnProvides and identifies appropriate resources to meet educational needs of staff, patient, physician or community agency
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nnCoordinates activities in conjuction with other multidisciplinary team members to meet educational needs.4. Coordinates discharge planning between community agencies, interdisciplinary team, patients/families and physicians.
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nnnIdentifies appropriate level of care for nursing home placement/extended care
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nnCompletes FL2, PASARR approval process
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nnMaintains working knowledge of financial and community resource regulations/availability
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nnCoordinates continuity of care in order to facilitate transition from LMH.5. Serves as a resource person for families, staff, community agencies and physicians.
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nnnAssists with learning needs of staff
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nnParticipates in job-related seminars and in service education
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nnServes on hospital committees addressing managed care/length of stay
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nnUtilizes resources as appropriate
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nnCollaborates with other health care professionals in order to provide comprehensive quality care to patients and families.6. Demonstrates Autonomy.
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nnnCompletes tasks as assigned
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nnSeeks and accepts additional job responsibilities and learning experiences
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nnSets priorities according to patient needs
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nnOperates within parameters of hospital and department policies
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nnDemonstrates appropriate time management
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nnSeeks opportunities for professional growth
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nnTakes personal responsibility and initiative for performance and for professional growth and development.7. Coordinates/promotes patient teaching.
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nnnPromotes education and implementation of AMD and DNR, documents to patients as needed.
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nnProvides and identifies appropriate resources to meet education needs of staff, patient, physician or community agency.
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nnCoordinates activities to facilitate learning in accordance to needs assessment.
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nnIncludes patient/family and/or significant other in patient education plan.
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n nOther information:
nnnEDUCATION
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nnGraduate from an accredited school of nursing or Medical Social Worker. Baccalaureate Degree in Human Services area accepted.
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nnEXPERIENCE
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nnThree to four years experience in hospital, nursing home, or community agency.
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nnLICENSURE/REGISTRATION/CERTIFICATION
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nnCertification by American Board of QA/UR or InterQual, Certification in Social Work, Licensed in N.C. for RN or LPNObtain Case Manager Certification within 5 years.
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n nJob Details
nLegal Employer: Lenoir Health
nEntity: UNC Lenoir Health Care
nOrganization Unit: Care Management
nWork Type: Per Diem
nStandard Hours Per Week: 4.00
nWork Assignment Type: Onsite
nWork Schedule: Day Job
nLocation of Job: LENOIR MEM
nExempt From Overtime: Exempt: No
nQualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
nQualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Worksite address
kinston, NC, 28504, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.