Case Manager
Sigma Gamma Rho Sorority, Inc.
- Case ManagerUNC HealthKinston, NCNov 03, 2026Healthcare Services## Job Description**Description**Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.Summary:* The Case Manager coordinates the hospital’s utilization review activities. Completes CQI Monitors for RM Committee and assures compliance with Federal, State and Third Party Insurance guidelines. Coordinates discharge planning, patient teaching and other associated activities for discharge to nursing facilities or successful community re-entry.Responsibilities:1. **Monitors UR activities/resource utilization**a. Reviews for appropriateness of admission and continued stayb. Obtains patient precertification to prevent possible payor denialsc. Appropriately follows through with Payor Denials with appeal processd. Confers with physician and/or refers to physician consultant when “Medical necessity” for admission or continued stay is questioned1. * Completes chart review within 24 working hours and obtains precertification within 48 working hours to appropriately monitor UR activities and prevent payor denials.2. **Interviews patients/families and records in Medical Record, Makes referrals.**2. 0. Documenting psychosocial, financial, cultural, domestic violence and protective services situations. Refers if necessary. 1. Develops plan to meet needs 2. Provides brief counseling services * Completes case findings, assessments, and treatment plans as per policy in order to provide effective intervention.3. **Coordinates/promotes patient teaching.**3. 0. Provides education and implementation of AMD and DNR, documents to patients as needed 1. Provides and identifies appropriate resources to meet educational needs of staff, patient, physician or community agency * Coordinates activities in conjuction with other multidisciplinary team members to meet educational needs.4. **Coordinates discharge planning between community agencies, interdisciplinary team, patients/families and physicians.**4. 0. Identifies appropriate level of care for nursing home placement/extended care 1. Completes FL2, PASARR approval process 2. Maintains working knowledge of financial and community resource regulations/availability * Coordinates continuity of care in order to facilitate transition from LMH.5. **Serves as a resource person for families, staff, community agencies and physicians.**5. 0. Assists with learning needs of staff 1. Participates in job-related seminars and in service education 2. Serves on hospital committees addressing managed care/length of stay 3. Utilizes resources as appropriate * Collaborates with other health care professionals in order to provide comprehensive quality care to patients and families.6. **Demonstrates Autonomy.**6. 0. Completes tasks as assigned 1. Seeks and accepts additional job responsibilities and learning experiences 2. Sets priorities according to patient needs 3. Operates within parameters of hospital and department policies 4. Demonstrates appropriate time management 5. Seeks opportunities for professional growth * Takes personal responsibility and initiative for performance and for professional growth and development.7. **Coordinates/promotes patient teaching.**7. 0. Promotes education and implementation of AMD and DNR, documents to patients as needed. 1. Provides and identifies appropriate resources to meet education needs of staff, patient, physician or community agency. * Coordinates activities to facilitate learning in accordance to needs assessment. * Includes patient/family and/or significant other in patient education plan.### Other information:* **EDUCATION**+ Graduate from an accredited school of nursing or Medical Social Worker. Baccalaureate Degree in Human Services area accepted. Obtain Case Manager Certification within 5 years.* **EXPERIENCE**+ Three to four years experience in hospital, nursing home, or community agency.* **LICENSURE/REGISTRATION/CERTIFICATION**+ Certification by American Board of QA/UR or InterQual, Certification in Social Work, Licensed in N.C. for RN or LPN* **OTHER SKILLS AND QUALIFICATIONS**Possess knowledge skills of InterQual ISD-A criteria. Good interpersonal and communication skills. Demonstrates understanding of patient care needs according to developmental stages for various age groups. Knowledge of State and Federal Regulations regarding admission/reimbursement of Medicare/Medicaid/all other payor sources. Reading and mathematics. Must be able to work autonomously### **Job Details**Legal Employer: Lenoir HealthEntity: UNC Lenoir Health CareOrganization Unit: Care ManagementWork Type: Per DiemStandard Hours Per Week: 4.00Work Assignment Type: OnsiteWork Schedule: Day JobLocation of Job: LENOIR MEMExempt From Overtime: Exempt: No Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.### About UNC HealthOur mission is to improve the health and well-being of North Carolinians and others whom we serve. We accomplish this by providing leadership and excellence in the interrelated areas of patient care, education and research. UNC Health and its 33,000 employees, continue to serve as North Carolina’s Health Care System, caring for patients from all 100 counties and beyond our borders. We continue to leverage the world class research conducted in the UNC School of Medicine, translating that innovation to life-saving and life-changing therapies, procedures, and techniques for the patients who rely on us.
- J-18808-Ljbffr Sigma Gamma Rho Sorority, Inc.
Vacancy posted 1 day ago
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