Case Manager

Case Manager

Requisition Number: 3919
Job Title: Case Manager
Department: UUH ENT 10H UUHC PLANS MSO
Reg / Temp: Regular
Employment Type: Full Time
Shift: Days
Work Schedule: M - F
Location: BUSINESS SERVICES BUILDING - 127 SOUTH 500 EAST
City: SALT LAKE CITY
State: UTAH

Job Description:
: As a patient-focused organization, the University of Utah Health Sciences 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. The Health Sciences Center seeks faculty and staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission.

Essential Functions:
- Review medical services (pre and post) for health plan enrollees to determine medical necessity, benefits/coverage, pre-existing, etc.
- Maintain documentation of decision making process and determination in the referral module of Epic.
- Communicate decisions with Coordinator and/or Provider and Patient/Family
- Identifies patient health improvement needs, including cultural needs, and ensures they are addressed.
- Coordinates care and resources with physicians, social workers, and other team members to achieve optimal patient outcomes.
- Identifies patients who are suitable for case management intervention based on criteria such as cost, case complexity, or frequency of admission. Educates patients regarding disease, self help, provider networks, coverage, resources, etc..
- Facilitates cost effective outcomes by determining appropriate level of care based on diagnosis, severity, intensity of services required, and other relevant criteria, using national and regional length of stay standards and community norms. Concurrently reviews inpatient hospital stays.
- Assesses and discusses benefit issues with client, family, and healthcare providers to enhance cost effective utilization of services and quality outcomes.
- Negotiates with third party payers and out of network providers for approved services.
- Identifies actual and potential delays in service requests or treatment and communicates them to health care team so steps can be taken to eliminate or minimize delays.
- Works with other team members to plan appropriate and timely delivery of services.

Knowledge / Skills / Abilities:

- Ability to perform the essential functions of the job as outlined above.
- Demonstrated team leadership, relationship building, critical analysis, and written and verbal communication skills.
- Knowledge of funding resources and clinical standards and outcomes.
- Demonstrated independent judgment to assess and meet client needs. A major challenge is interaction with patients, families, various patient care disciplines, ancillary departments, health care and community agencies, third party payors, and Health Science Center professional schools in coordinating care and services for patients.

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Qualifications:
Required:

- Current RN licensure in the State of Utah.
- Two years of professional experience in a clinically related area.
- Basic Life Support Health Care Provider card or must obtain one within one month of hire.

Position Summary:
Provides clinical case management services aimed at patient assessment, enhancing patient-centered care and maximizing outcomes across the patient care continuum. Case management services include monitoring patient care to ensure progress toward desired outcome, addressing patient and family needs, resolving obstacles to effective care, planning for patient discharges, navigating through the insurance maze, customer service. Provides utilization management services that include review for medical necessity, benefit/coverage, and pre-existing conditions.