Under the direction of the Director, Care Coordination, the Case Manager performs activities which support the Case Management/Utilization Management function. The Case Manager promotes optimal health care outcomes in accordance with the policies, procedures, applicable laws and contracts, philosophy, mission and values of University Hospital; assumes responsibility and accountability for the appropriate utilization of facilities and services; serves as a resource to physicians; conducts admission and concurrent reviews including observation and inpatients; identifies patients who do not meet criteria and takes action to ensure patients are cared for in the most appropriate level of care; coordinates care in conjunction with other members of the interdisciplinary healthcare team to provide and facilitate optimal health care/discharge planning; utilizes the nursing process (assess, plan, implement and evaluate) and management process (plan, organize, direct and control) to provide a framework for decision-making; maintains confidentiality of information; actively supports organizational goals and objectives by providing needed information to divisions and departments.
Certifications: RN license in Kentucky required. Certification in a nursing specialty area or CCM preferred.
Education: BSN or RN with a Bachelors Degree in Business or Health Care Administration preferred. Will consider RN with A.D.N. if actively pursuing BSN, with BSN completion required within 2 years of hire.
Experience: Must have 2-3 years experience as an RN plus utilization management or discharge planning/case management experience. Minimum two years experience performing utilization review and/or quality assurance activities in an acute care facility or HMO/PPO/PRO preferred. Must be able to adjust priorities quickly, organize multiple tasks simultaneously, and work interdependently with many levels of staff. Attention to detail; strong organizational, interpersonal and communication skills; and innovative problem solving skills required. Must be able to adjust work hours depending on depending upon departmental needs as determined by the director or manager.