Case Manager

About Us

We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros.

Position Overview

The purpose of this position is to provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The goal of the position is to enhance the quality of patient care through innovative and cost-effective best practices. This position promotes the integration of case management, utilization review, discharge planning, denial management and patient transfer management to ensure successful continuity care.

Essential Job Functions

• Ensure patient progression through continuum of care
• Ensure compliance during all admission and transfer processes
• Document patient outcomes during and after each coordination of care
• Maintain patient health information privacy at all times
• Coordinate transfer center admission and/or transfer requests as required
• Coordinate and complete daily patient continuum reports as required
• Complete and ensure Utilization Review of all admissions
• Maintain regulatory compliance with CMS Conditions of Participation
• Record and report extended delays in care
• Coordinate discharge planning
• Monitor and update discharge planning resources
• Perform denial management responsibilities
• Coordinate payer communication
• Act as a patient advocate: investigate and report adverse occurrences and perform staff education related to resource utilization, discharge planning and all other pertinent aspects of healthcare delivery
• Collaborate with clinical staff in development and execution of the plan of care and achievement of goals
• Minimal travel may be required
• Perform other duties as assigned

Basic Qualifications

• Compact Registered Nurse (RN) license, required
• 2 years hospital clinical experience, required
• Bachelor’s Degree, strongly preferred
• Utilization Review/Case Management experience, preferred
• Active Case Management Certification or other professional RN Certification, preferred
• InterQual and/or Milliman experience, preferred
• Superior interpersonal skills
• Ability to establish and maintain collaborative, effective working relationships
• Ability to communicate professionally and effectively in oral, written and electronic formats
• Demonstrate analytical and critical thinking abilities with proactive decision-making and negotiating skills
• Demonstrate professional organizational skills
• Ability to manage multiple tasks simultaneously
• Position requires fluency in English; written and oral communication