Case Manager - RN

Case Manager (RN) – Fulltime Location: Aiken, South Carolina – Aiken Regional Medical Centers, a 273‑bed acute care facility, has served its community since 1917. The hospital offers comprehensive services including behavioral health, emergency care, orthopedic surgeries, maternity, rehabilitation, imaging, and wound care. Responsibilities Conduct admission, concurrent, and retrospective reviews for all patient populations to ensure appropriate admission and continued stay. Collaborate with payers to reduce denial risk and manage cases from admission through discharge. Monitor patient progression and readiness for discharge, initiating interventions to minimize avoidable days and delays. Work with interdisciplinary team members and external partners to support timely transitions of care. Perform discharge planning as needed, ensuring smooth transition for all patients on assigned units. Execute chart reviews to certify admission appropriateness, accuracy of status, and to reduce denial risks. Follow departmental processes for denied cases, managing peer‑to‑peer or VH appeals and facilitating VH re‑consideration requests. Refer all OBS cases to VERSALUS HEALTH and follow up to ensure order status changes. Maintain relationships with insurance companies to share clinical information for payment authorization and limit denial risk. Overturn denials during the patient’s stay, ensuring documentation supports admission or continued stay. Identify and document avoidable hospital days, initiating necessary interventions to minimize discharge delays. Educate medical and nursing staff on utilization of hospital days and resources. Manage referrals to Infection Control, Wound Care, Nutrition/Dietary, and Peer Review departments as appropriate. Collaborate with medical staff and departments to develop clinical practice guidelines for designated patient groups. Qualifications Education : Diploma or associate degree from an accredited Registered Nursing program; BSN preferred. Experience : Minimum of 3 years in an acute‑care hospital or related setting with prior utilization review or case management experience. Licensure : SC RN license or compact state license. Skills : Knowledge of private insurance and Medicare hospitalization criteria, understanding of healthcare financial systems and benchmarking practices, facilitation of change through interdisciplinary collaboration, and computer proficiency. Benefits Sign‑on bonuses for select positions Unlimited Employee Referral Bonus Program Competitive Compensation & generous paid time off Excellent medical, dental, vision, and prescription drug plans Tuition/Certification reimbursement after 6 months Culture of excellence – employee recognition program Challenging and rewarding work environment Clinical nursing ladder opportunities SoFi student loan refinancing program 401(K) with company match and discounted stock plan Career development opportunities within UHS and its 300+ subsidiaries EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal‑opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion, and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. #J-18808-Ljbffr Aiken Regional Medical Centers