Case Manager New! Case Management | Full-Time | Phoenix ...Read More Quick Apply! Case Manageme[...]

Job Summary Case Manager provides comprehensive care coordination for assigned patients, assessing plans of care, managing length of stay, discharge planning, advocating resources and supporting the clinical roadmap. The role works independently under the supervision of the Lead CM team and is accountable for the quality of clinical services delivered by the team and community partners. Position Duties Coordinate care and manage a defined service line patient population to achieve optimal discharge and continuity of care outcomes. Establish estimated Length of Stay using MCG criteria and tools, completing an initial screen within 24 hours of admission. Develop and implement comprehensive discharge care plans in collaboration with the clinical care team, ensuring documentation is complete and updated. Facilitate referrals, monitor follow‑up, and resolve discrepancies in the plan of care that affect length of stay. Provide ongoing communication with patients and families, escalating unresolved barriers to timely discharge to Case Management or Utilization Management Medical Director. Analyze third‑party payer denials, communicate outcomes to physicians, case managers, managers, and Utilization Management staff per protocols. Maintain effective interaction with the interdisciplinary care team and engage patients and families across the continuum of care. Review patient status daily, communicate goal length of stay to the clinical team, patient, and family. Keep patient discharge information current in the Case Manager EMR documentation. Participate in interdisciplinary rounds and service line rounds with the clinical care team. Ensure thorough early and ongoing transition/discharge plans, assess postoperative placement, consult social services, and communicate plans to other case managers. Validate family and patient understanding of the discharge plan through documentation and feedback. Provide unit and team leadership, serving as the central information point for patient status and goal length of stay. Perform miscellaneous job‑related duties as requested. Regulatory Responsibilities Daily review of patient status (Observation and Inpatient) to meet admission or discharge criteria. Obtain and review medical reports and treatment plan requests for ongoing care planning and discharge planning. Use MCG guidelines/pathways to determine admission status, level of care, goal length of stay, and service provision. Document avoidable days, extended length of stay, authorizations and denials for medical necessity in SCM and SAM. Communicate to the Utilization Management Nurse data supporting denial appeals or potential denials. Communicate with payers to resolve potential denials. Maintain working knowledge of DRG payment methodology and ICD‑9/10 coding system. Provide Medicare/Tricare Rights and Detailed Notice of Discharge to patients and families. Mission, Vision & Values Mission : To advance hope, healing, and the best healthcare for children and their families. Vision : Phoenix Children’s will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education. Values : We place children and families at the center of all we do. We deliver exceptional care, every day and in every way. We collaborate with colleagues, partners and communities to amplify our impact. We set the standards of pediatric healthcare today, and innovate for the future. We are accountable for making the highest quality care accessible and affordable. Position Qualifications Education Bachelor’s degree in Nursing or a combination of Associate degree in Nursing plus 3 years clinical experience (required). Master’s degree in Nursing (preferred). Experience Minimum 1 year of broad clinical experience; care coordination, case management, discharge planning, and utilization review experience preferred (required). Working knowledge of third‑party payer financial aspects and reimbursement (preferred). Working knowledge of evidence‑based guidelines to manage length of stay (preferred). Special Skills Bilingual (Spanish) – preferred. MCG criteria knowledge – preferred. Excellent communication skills, both verbal and written – required. Effective critical thinking skills and ability to anticipate patient discharge needs – required. Moderate to expert computer skills – required. Effective decision‑making/problem‑solving skills, creativity, and influential leadership – required. Additional Requirements Current state of Arizona RN license – required. Case Management Certification (CCM) – preferred. Current BLS certification for healthcare provider from the American Heart Association – required. Valid AZ Department of Public Safety (DPS) Fingerprint Clearance Card – required. Valid Compact State RN license – required. Certification / License / Registry Requirements for the Position AZ RN License OR Compact to Arizona License OR Compact State – required. Basic Life Support – required. Case Management Certification – preferred. Fingerprint Clearance Card – required. Physical Requirements & Occupational Exposure / Risk Potential Fine Motor Skills (pinching, gripping, etc.) – occasionally. Hearing – constantly. Pushing/pulling – occasionally. Reaching – occasionally. Sitting – constantly. Standing – constantly. Stooping/crouching/kneeling/crawling – occasionally. Talking – constantly. Walking – constantly. Near Vision – constantly. Far Vision – constantly. Use of keyboard, mouse and/or computer equipment – constantly. Lift up to 35 pounds without assistance – occasionally. Occupational exposure / risk potential: Inside office environment – applicable. Airborne communicable diseases – applicable. Bloodborne pathogens or bodily fluid – applicable. #J-18808-Ljbffr Phoenix Children's Hospital, Inc.