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Case Manager
Career Insights for Nurse Case Manager
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Scorecard
Based on South Carolina data
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What they do
A Nurse Case Manager applies nursing expertise to coordinate a patient's medical care and provides advocacy to help them get the best and most affordable care. Develop care plans including discharge planning, coordinate delivery among providers, and teach patients and families how to follow the plan. They may also help patients navigate insurance and other healthcare bureaucracies and access related social services. May work with patients who have chronic illnesses or other complex medical needs. Works at a hospital or other healthcare facility; may follow patients throughout the span of their treatment.
$68,854 / year median in South Carolina
+0% projected growth
Job Description
Monitor patient experience:
quality/timeliness/service appropriateness/payors/expectations. Facilitate team conferences weekly and coordinate all treatment plan modifications. Complete case management addendums and all required documentation. Maintain knowledge of regulations/standards, company policies/procedures, and department operations. Review/analyze case management reports, including Key Care Indicators, and plan appropriate actions. Understand commercial contract levels, exclusions, payor requirements, and recertification needs. Attend Acute Care Transfer (ACT) meetings to identify trends and collaboratively reduce ACTs. Meet with patient/family per Patient Arrival and Initial Visit Standard within 24 hrs of admission. Perform assessment of goals and complete case management addendum within 48 hours of admission. Educate patient/family on rehabilitation and Case Manager role; establish communication plan. Schedule and facilitate family conferences as needed. Assist patient with timely procuring/planning of resources to avoid discharge delays or issues. Monitor compliance with regulations for orthotics and prosthetics ordering and payment. Make appropriate/timely referrals, including documentation to post discharge providers/physicians. Ensure accuracy of discharge and payor-related information in the patient record.Participate in utilization review process:
data collection, trend review, and resolution actions. Participate in case management on-call schedule as needed.Qualifications License or Certification:
Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling). If licensure is required for one's discipline within the state, individual must hold an active license. Must meet eligibility requirements for CCM® or ACM™ certification upon entry into this position OR within two years of entry into the position. CCM® or ACM™ certification required OR must be obtained within two years of being placed in the Case Manager II position.Minimum Qualifications:
For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN preferred. A diploma is acceptable only in those states whose minimum requirement for licensure or certification is a diploma rather than an Associate Degree. For all other eligible licensed or certified health care professionals, must possess a minimum of a bachelor's degree and graduate degree is preferred. 2 years of rehabilitation experience preferred. The Encompass Health Way We proudly set the standard in care by leading with empathy, doing what's right, focusing on the positive, and standing stronger together. Encompass Health is a trusted leader in post-acute care with over 150 nationwide locations and a team of 36,000 exceptional individuals and growing! At Encompass Health, we celebrate and welcome diversity in our inclusive culture. We provide equal employment opportunities regardless of race, ethnicity, gender, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental or physical disability, or any other protected classification.Benefits
- Paid Time Off (PTO)
- Financial Aid/Assistance
- 401(k) Plans
- Employee Stock Options (ESOs)