Case Management Nurse

Overview As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA This position provides clinical case management services aimed at enhancing patient-centered care and maximizing outcomes across the patient care continuum from pre‑admission through post‑discharge. The case manager monitors patient care to ensure progress toward desired outcomes, addresses patient and family needs, resolves obstacles to effective care, coordinates care with payers and vendors, patients and families, and establishes, monitors and executes patients' discharge plans. The position may be required to access and administer medications within the scope of practice and according to State Law. Responsibilities Coordinate case management processes from patient entry into the healthcare system to post‑discharge, including outpatient settings. Coordinate care and resources with physicians, social workers, and other team members to achieve optimal patient outcomes. Identify patients suitable for case management intervention based on criteria such as cost, case complexity, frequency of admission, or request from patients, families, providers, or other team members. Monitor and document quality of care to ensure patient care plan goals are appropriate and implemented; assess client and family response to services and measure plan effectiveness. Identify and address patient needs, including ethical and cultural considerations. Facilitate cost‑effective outcomes by determining appropriate level of care based on diagnosis, severity, and intensity of services required. Assess and discuss funding and insurance issues with clients, families, and healthcare providers to enhance cost‑effective utilization of services. Negotiate with third‑party payers regarding benefit levels, eligibility, utilization review, and reimbursement. Identify potential delays in service requests or treatment and communicate them to the healthcare team to eliminate or minimize delays. Work with team members to plan appropriate and timely discharges. Establish measurable discharge planning and self‑management goals that promote safe, cost‑effective, high‑quality outcomes. Provide oversight of issuance of CMS Important Message to patients. Supervise technical support staff assigned to individual case management teams. Schedule patient follow‑up appointments and perform post‑discharge phone calls per care team design. Conduct home or site visits as required by the department. Work rotating schedules, which may include variable hours, weekends, nights, and holidays to meet the staffing and patient care demands of a 24/7 complex health system; reliable attendance during assigned shifts is essential. Knowledge, Skills, and Abilities Perform essential job functions as described above. Availability to work variable and rotating shifts, including nights, weekends, and holidays. Team leadership, relationship building, critical analysis, and written and verbal communication skills. Knowledge of funding resources, clinical standards, and outcomes. Provide care appropriate to the population served. Independent judgment to assess and meet client needs, with meaningful outcome‑oriented dialogues with patients, families, disciplines, agencies, payers, and university programs. Knowledge of life‑span development principles and ability to assess patient status data per department policies. Qualifications Two years of professional experience in a clinically related area. Depending on the department, reliable transportation may be required for site visits. Licenses Required One of the following: Current license to practice as a Registered Nurse in Utah, or obtain within 90 days of hire under the interstate compact if switching residency to Utah; maintain current multi‑state license if residency is not changed. Current licensed Clinical Social Worker (L.C.S.W.) certificate in Utah. Current license to practice as a Clinical Mental Health Counselor in Utah. Current license to practice as a Physical Therapist in Utah, or obtain within 90 days under the Physical Therapy Compact if switching residency; maintain current compact license if residency is not changed. Current licensure to practice as an Occupational Therapist in Utah. Additional license requirements may be determined by the hiring department. Preferred Qualifications Basic Life Support Health Care Provider card through the American Heart Association. A Certified Case Management designation. Previous experience in clinical resource management activities and third‑party payer interactions. Working Conditions and Physical Demands Employees must be able to meet the following requirements with or without an accommodation. Light work that may exert up to 20 pounds and may consistently require light lifting, carrying, pushing, pulling, or moving objects related to patient care or medical equipment. This position does not provide direct patient care. Workers may be exposed to infectious diseases and may be required to function around prisoners or behavioral health patients. Physical Requirements Carrying, climbing, color determination, far vision, lifting, listening, manual dexterity, near vision, pulling and/or pushing, reaching, sitting, speaking, standing, stooping and crouching, walking. #J-18808-Ljbffr