About this opportunity
UNC Health lists this Case Manager opportunity in kinston, North Carolina. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Case Manager
Your 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.
Summary: The 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.
Responsibilities:
Monitors UR activities/resource utilization Reviews for appropriateness of admission and continued stay
Obtains patient precertification to prevent possible payor denials
Appropriately follows through with Payor Denials with appeal process
Confers with physician and/or refers to physician consultant when "Medical necessity" for admission or continued stay is questioned
Completes chart review within 24 working hours and obtains precertification within 48 working hours to appropriately monitor UR activities and prevent payor denials.
Interviews patients/families and records in Medical Record, Makes referrals Documenting psychosocial, financial, cultural, domestic violence and protective services situations. Refers if necessary.
Develops plan to meet needs
Provides brief counseling services
Completes case findings, assessments, and treatment plans as per policy in order to provide effective intervention.
Coordinates/promotes patient teaching Provides education and implementation of AMD and DNR, documents to patients as needed
Provides and identifies appropriate resources to meet educational needs of staff, patient, physician or community agency
Coordinates activities in conjunction with other multidisciplinary team members to meet educational needs.
Coordinates discharge planning between community agencies, interdisciplinary team, patients/families and physicians Identifies appropriate level of care for nursing home placement/extended care
Completes FL2, PASARR approval process
Maintains working knowledge of financial and community resource regulations/availability
Coordinates continuity of care in order to facilitate transition from LMH.
Serves as a resource person for families, staff, community agencies and physicians Assists with learning needs of staff
Participates in job-related seminars and in service education
Serves on hospital committees addressing managed care/length of stay
Utilizes resources as appropriate
Collaborates with other health care professionals in order to provide comprehensive quality care to patients and families.
Demonstrates Autonomy Completes tasks as assigned
Seeks and accepts additional job responsibilities and learning experiences
Sets priorities according to patient needs
Operates within parameters of hospital and department policies
Demonstrates appropriate time management
Seeks opportunities for professional growth
Takes personal responsibility and initiative for performance and for professional growth and development.
Coordinates/promotes patient teaching Promotes education and implementation of AMD and DNR, documents to patients as needed.
Provides and identifies appropriate resources to meet education needs of staff, patient, physician or community agency.
Coordinates activities to facilitate learning in accordance to needs assessment.
Includes patient/family and/or significant other in patient education plan.
Other information:
EDUCATION Graduate from an accredited school of nursing or Medical Social Worker. Baccalaureate Degree in Human Services area accepted.
EXPERIENCE Three to four years experience in hospital, nursing home, or community agency.
LICENSURE/REGISTRATION/CERTIFICATION Certification by American Board of QA/UR or InterQual, Certification in Social Work, Licensed in N.C. for RN or LPN Obtain Case Manager Certification within 5 years.
Worksite address
kinston, NC, 28504, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.