Utilization Review

Case Manager

Would you like to take your RN career to the next level, making a difference in the lives of patients and their families? Consider joining our team as a Case Manager! We offer exceptional insurance and benefits along with a positive and productive work environment. Interested applicants, please apply today!

Job Summary: Assesses, develops, plans, implements, and evaluates patients discharge planning needs to next level of care in collaboration with interdisciplinary team.

Job Responsibilities and Requirements:

• Ensures compliance with Condition of Participation (CoP) discharge planning.
• Identifies and escalates gaps/barriers related to inpatient and observation length of stay.
• Assesses patients at high risk for readmission. Identifies root cause for readmission. Develops plan and collaborates with multidisciplinary team regarding discharge planning to next level of care.
• Participates with other members of team regarding opportunities for improvement in standard work.
• May also be responsible for: utilization management process, ED case management process, admission process, and act as a case manager liaison with post acute providers (skilled nursing facilities, rehab, home health, etc.).
• Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patients age-specific needs and clinical needs as described in the department's Scope of Service.
• As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model. Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations.
• Works in a constant state of alertness and safe manner.
• Performs other duties as assigned.

Education: Graduate of accredited school of nursing or education equivalency for licensing

Experience: Three years' acute care experience

Physical Requirements: Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements. Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc. Frequent keyboard use/data entry. Occasional bending, stooping, kneeling, squatting, twisting and gripping. Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. Rare climbing.

Required Professional License and/or Certifications State of Work Location: Missouri Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Missouri Division of Professional Registration

Work Shift: Day Shift (United States of America) Job Type: Employee Department: Case Management Scheduled Weekly Hours: 40

Benefits: SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

• Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay(fees may apply)before payday.
• Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members.

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law.