Case Manager RN Position Available In Aiken, South Carolina

Job Description:

Responsibilities Case Management(RN) – Fulltime Aiken RegionalMedical Centers, located in Aiken, South Carolina, is a 273-bedacute care facility providing top quality and safe healthcare tothe residents of Aiken and surrounding communities since 1917.Aiken Regional Medical Centers has been ranked a top hospital inSouth Carolina by the American Heart Association for its treatmentof heart attack, heart failure and Stroke, and most recently,coronary artery disease. Additionally, Aiken Regional providescomprehensive healthcare services such as behavioral health (Aurora Pavilion Behavioral Health ), emergency medical care (mainhospital and ER at Sweetwater ), orthopedic surgeries, maternity,rehabilitation services( Hitchcock Rehabilitation Services ),imaging, and wound care.

Visit us online at:

https://www.aikenregional.com The Case Manager is responsible foradmission, concurrent and retrospective medical review of allpatient populations for documentation of appropriateness ofadmission and continued stay. This position requires closecollaboration and communication with payers to reduce risk ofdenials by continued management of all assigned cases fromadmission to discharge. Responsible for managing assigned patientpopulation for progression of medical management and readiness fordischarge. This includes the initiation of interventions to reduceand eliminate avoidable days, opportunity days and delays in care;works in collaboration with interdisciplinary team members internaland external to the organization; participates in processimprovement and evaluation process related to the management ofpatient care and resource utilization. Responsible for working inclose collaboration with the assigned SW/DCP on the floor to ensurea safe and timely transition of care, with the goal of managementof LOS and utilization of resources on their assigned units.

Performs discharge planning as needed to ensure timely transitionof care of all patients on the assigned unit.

Duties:

Performschart reviews (admission, concurrent and retrospective, asnecessary) for all payor sources in order to certifyappropriateness of admission, accurate status, continued stay andreduce denial risks. Follows department processes for management ofdenied cases, refers these cases for Peer to Peer or for VH appeal.

Sends updated clinical to request reconsideration when appropriate.

Follows department process for referrals to

VERSALUS HEALTH

for allOBS cases and follows up after review to facilitate order statuschanges as appropriate. Monitors all patients on their assignedfloor for progression of care and clinical readiness for dischargeand works with their SW/DCP partner to limit delays in transitionof care by performing discharge planning as needed in the assignedunit. Works in collaboration with partner, nursing, and othermembers of the Interdisciplinary team to anticipate discharges forthe next day and provides this information to clinical staff at theend of each day. Maintain strong relationship with insurancecompanies to share clinical information for payment authorizationand limit risk of denials. Follows and continues to work deniedcases in an effort to overturn denials while patients are still inhouse. Collaborates with members of the healthcare team to ensuredocumentation supports admission or continued stay whendocumentation is not clear to ensure appropriateness of acutehospital stay. Identifies and documents, and manages avoidablehospital days according to defined criteria and initiatesappropriate intervention as necessary to minimize discharge delays.

Educates medical staff, nursing and other members of the healthcareteam regarding utilization of hospital days and resources.

Identifies and makes referrals to other departments such asInfection Control, Wound Care, Nutrition/Dietary, and Peer Reviewas appropriate. Collaborates with Medical staff and otherdepartments as appropriate to facilitate development of clinicalpractice guidelines for designated patient groups. BenefitHighlights Sign On Bonuses for select positions Unlimited EmployeeReferral Bonus Program Competitive Compensation & Generous PaidTime Off Excellent Medical, Dental, Vision and Prescription DrugPlans Tuition/Certification Reimbursement after 6 months Culture ofExcellence – Employee Recognition program Challenging and rewardingwork environment Clinical Nursing Ladder opportunities SoFi StudentLoan Refinancing program 401(K) with company match and discountedstock plan Career development opportunities within UHS and its 300Subsidiaries! More information is available on our

Benefits GuestWebsite:

uhsguest.com About Universal Health Services One of thenation’s largest and most respected providers of hospital andhealthcare services, Universal Health Services, Inc. (

NYSE:

UHS)has built an impressive record of achievement and performance,growing since its inception into a Fortune 500 corporation.

Headquartered in King of Prussia, PA, UHS has 99,000 employees.

Through its subsidiaries, UHS operates 28 acute care hospitals, 331behavioral health facilities, 60 outpatient and other facilities in39 U.S. States, Washington, D.C., Puerto Rico and the UnitedKingdom.

Qualifications Requirements:

Education requirements:

Diploma or associates degree from an accredited Registered Nursingprogram. BSN preferred.

Work experience requirements:

Minimum of 3years experience in acute-care hospital or related setting;previous utilization review or case management experience. Requiredlicenses/ certifications/courses SC RN license or compact statelicense. Required skills, knowledge and abilities: Knowledge ofprivate insurance, Medicare criteria for hospitalization,understanding of healthcare financial systems, benchmarkingpractices; Experience in facilitating change throughinterdisciplinary collaboration; computer skills. EEO Statement AllUHS subsidiaries are committed to providing an environment ofmutual respect where equal employment opportunities are availableto all applicants and teammates. UHS subsidiaries are equalopportunity employers and as such, openly support and fully committo recruitment, selection, placement, promotion and compensation ofindividuals without regard to race, color, religion, age, sex(including pregnancy, gender identity, and sexual orientation),genetic information, national origin, disability status, protectedveteran status or any other characteristic protected by federal,state or local laws. Avoid and Report Recruitment Scams We areaware of a scam whereby imposters are posing as Recruiters fromUHS, and our subsidiary hospitals and facilities. Beware of anyonerequesting financial or personal information. At UHS and all oursubsidiaries, our Human Resources departments and recruiters arehere to help prospective candidates by matching skill set andexperience with the best possible career path at UHS and oursubsidiaries. During the recruitment process, no recruiter oremployee will request financial or personal information (e.g.,Social Security Number, credit card or bank information, etc.) fromyou via email. Our recruiters will not email you from a publicwebmail client like Hotmail, Gmail, Yahoo Mail, etc. If you suspecta fraudulent job posting or job-related email mentioning UHS or itssubsidiaries, we encourage you to report such concerns toappropriate law enforcement. We encourage you to refer tolegitimate UHS and UHS subsidiary career websites to verify jobopportunities and not rely on unsolicited calls fromrecruiters.