Join to apply for the Case Manager role at Cape Cod Healthcare.
Get AI-powered advice on this job and more exclusive features.
Responsibilities
1. Screen new admissions daily for discharge planning needs, establish visit priorities based on screening criteria, verify demographic and payer information, and notify admissions of corrections.
2. See patients with follow-up needs within one (1) business day, complete initial assessments in InterQual, and perform reassessments every three (3) days as needed.
3. Review admission appropriateness and level of care needs using InterQual Criteria, following policies if criteria are not met.
4. Initiate timely HINN Notices, letters of reinstatement, and coordinate patient appeal rights under the Discharge Appeals program.
5. Identify high-risk patients and refer them to appropriate resources.
6. Manage utilization review, facilitate third-party reimbursements, and respond to payer requests for clinical information.
7. Collaborate with physicians and the interdisciplinary team to ensure care plans are appropriate and aligned with patient needs and coverage.
8. Participate in unit’s daily rounds and advocate for patients by developing partnerships with families, payers, and healthcare teams.
9. Coordinate and communicate referral information for safe patient transfers, complete necessary paperwork, and demonstrate knowledge of community resources.
10. Apply standards of care, participate in care conferences, and monitor patient’s clinical course.
11. Evaluate continued stay appropriateness, refer to Physician Advisor if needed, and identify days at risk for denial to facilitate discharge.
12. Maintain departmental policies, participate in education, and stay current with regulatory and payer requirements.
13. Perform other duties as assigned, work independently, and demonstrate flexibility and teamwork.
Qualifications
* Current RN registration in Massachusetts.
* Bachelor of Science in Nursing preferred; or 2 years of Case Management experience.
* Minimum 3 years acute care experience in hospital or case management within past 5 years.
* Recent experience in Discharge Planning and Utilization review within past 4 years.
* Knowledge of InterQual or equivalent system.
* Strong interpersonal, negotiation, organization, and time management skills.
* Proficiency with computer systems and ability to work independently in a fast-paced environment.
Position Details
Part-time, 24 hours/week, rotating days, 8 am - 4 pm, with occasional weekends and holidays.
Location: Falmouth Hospital, Massachusetts.
#J-18808-Ljbffr