Case Manager

JOB TITLE

Case Manager

SCHEDULE

Full Time

DEPARTMENT

Nursing

POSITION DESCRIPTION

The Case Manager's major function is to review and monitor patient admissions for proper level of service (status) and determine that standardized criteria have been met for admission, continued stay and discharge. The case manager serves as the primary contact for payors, providing appropriate admission, concurrent, retrospective reviews. In addition, the case manager serves as the clinical resource for progressing care, discharge planning, and transitions of care. The Case manager utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate physical and behavioral healthcare and social services for members through assessment and member-centered care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective outcomes, including swingbed services.

QUALIFICATIONS/REQUIREMENTS 2

year/ Associate degree from an accredited school of nursing, or Graduate of an accredited Vocational Nursing Program required, or Medical Assistant Certificate ; 4 year/Bachelor's preferred. Registered Nurse (RN) or Licensed Vocational Nurse (LVN) Licensure in the state of Texas upon hire required. Certified Case Management (CCM) or Certified Professional Utilization Review (CPUR) preferred.

EXPERIENCE 3-5

years clinical nursing experience required; 1-3 years case management or utilization experience preferred.