Case Manager

Roper St. Francis Health Care Charleston, SC
Job Details

Job Summary:

The Case Manager assumes a leadership role with the case management team to coordinate patient care including but not limited to pre-admission, social services, post-acute services and case management support staff. The Case Manager collaborates with the interdisciplinary healthcare team and patients/families/caregivers to expedite appropriate, cost effective, and safe quality care that optimizes patient flow and promotes an integrated and seamless patient-centered experience. This position ensures holistic, evidence-based care plans are consistent with patient's clinical course, continuing care needs, and covered services. The Case Manager is a resource to both internal and external stakeholders and assists in the education and guidance of the care team and patients/families/caregivers in shared decision making.

Minimum Qualifications:

Education: Graduate of an accredited school or college of nursing. BSN preferred, or required within five (5) years of hire or transfer date into position.

Experience: Minimum three year's clinical acute care experience as an RN or Case Manager within the last 5 years. Demonstrated leadership skills preferred. Utilization Review and Case Management experience preferred.

Licensure/Certification: Currently licensed as a Registered Nurse in the state of South Carolina or holds a current compact/multi-state license as a Registered Nurse in a recognized NCSBN Compact State and is not a permanent resident of SC. Utilization Review and Case Management certification preferred.

Primary Source Verification (if applicable): Nursing- SC Labor, Licensing and Regulation (LLR): or compact RN state licensing board.

Knowledge/Skills: Broad knowledge of health care delivery systems, utilization review and case review procedures including but not limited to InterQual/MCG criteria and other guidelines for medical necessity, setting and level of care, and concurrent patient management. Requires high level negotiation skills and confidence in communicating with and engaging in crucial conversations with physicians and other stakeholders. Expertise in federal and state requirements related to quality and transition of care.

Other: The successful candidate can demonstrate a strong track record of building and sustaining stakeholder and core team relationships. The ability to navigate within ambiguity, a service orientation, and a high level of humility are all requirements for successful assimilation into our highly collaborative, patient-centered culture. Ability to work in a fast pace team environment. Ability to prioritize and multi-task. Ability to make sound, independent clinical judgements and act professionally under pressure. Ability to develop and maintain positive relationships with physicians and entire healthcare team. Ability to maintain confidentiality of sensitive patient information. Fluent in system-wide PC applications Excel, Word and PowerPoint. Working knowledge of clinical systems where applicable which may include, STAR, CareManager, Cerner, Ensocare, etc. Professional development and continuous learning in a self-directed manner is imperative to the Case Manager's ability to perform essential functions of the role.