Nov 28, 2023

Case Manager

  • Vail Health
  • Vail, CO 81657, USA

Job Description

Case Manager

To us, it's about living life to the fullest while serving our patients, teammates, neighbors and friends. We are dedicated and passionate in everything we do, seeking challenge and appreciating the routes that got us here. Whether our path is clinical or not, we all came to find balance and meaning in our lives within the work we are passionate about and the adventures we live.

Vail Health has become the world’s most advanced mountain healthcare system. Our updated 520,000-square-foot hospital opened in December 2020. This state-of-the-art facility provides exceptional care to all of our patients, with the most beautiful views in the area, located centrally in Vail.

Some roles may be based outside of our Colorado office (as stated in the Job Title). Roles based outside of our primary office can sit in any of the following states: AZ, CO, CT, DC, FL, GA, ID, IL, KS, MA, MD, MI, MN, NC, NJ, OH, OR, PA, SC, TN, TX, UT, VA, WA, and WI. Please only apply if you are able to live and work primarily in one of the states listed above. State locations and specifics are subject to change as our hiring requirements shift.

About the opportunity:

Maximizes reimbursement for both patient and hospital through cooperation with third party payers and physicians. Follows up on denials based on resource utilization issues. Provides a smooth transition for the patient from hospital to home or alternative care setting through coordination of services to meet the post discharge needs identified while maintaining a balance among quality outcome, cost, and process. Identifies those patients with significant psychosocial needs and makes referrals to Social Services. Promotes continuous quality improvement by monitoring team processes as well as through communication with other teams impacted by or impacting the processes of this team.

What you will do:
  1. Monitors for appropriateness of admission, continued stay, and readiness for discharge based on department defined guidelines and criteria as evidenced by appropriate documentation. Demonstrates utilization review accuracy using Interqual criteria.
  2. Informs the patient and the attending physician when the patient doesn’t meet acute care criteria according to department criteria.
  3. Cooperates with other departments in defense of denial of services by reviewing the chart for documentation of appropriateness of the admission/continued stay as evidenced by provision of supporting chart documentation.
  4. Communicates with attending physicians when necessary.
  5. Identifies the post-hospital equipment and unmet care needs of the inpatient and The Medicare patient (including observation) beginning within 24 hours of notification of admission as evidenced by placement of the completed discharge planning needs assessment form in the social service section of the chart.
  6. Identifies the psychosocial needs of the patient and/or family and addresses those needs or make a referral to social services as appropriate as evidenced by documentation on the discharge planning needs assessment form.
  7. Identifies the unmet financial needs of the patient and addresses those needs or make a referral to Inpatient Admissions Representative for HELP program or Social Services as appropriate.
  8. Ensures that no services are denied for lack of clinical information when accurate contact numbers are received from Insurance Verification within the payer’s time-frame as evidenced by absence of denials which fall within the above guidelines.
  9. Follows-up with patients within 14 days post-discharge where discharge planning referrals were made to identify the adequacy / flaws in the process.
  10. Role models the principals of a Just Culture and Organizational Values.
  11. Perform other duties as assigned. Must be HIPAA compliant.
This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
What you will need:
  • One year recent experience in acute care hospital Utilization Review, Discharge Planning or equivalent.
  • Two years experience in case management if incumbent is a Licensed Practical Nurse (LPN).
  • Licensed as a Registered Nurse in the state of Colorado or from a valid compact state OR licensed as a Licensed Practical Nurse in the state of Colorado required
  • N/A
Computer / Typing:
  • Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
Must have working knowledge of the English language, including reading, writing, and speaking English.
  • Associates or Bachelor's degree in nursing.
  • Able to pass annual inter-rater reliability competency exam (IRR) with a score of 80%.
Pay is based upon relevant education and experience.
Pay Range:
$1$2 USD

Benefits at Vail Health

  • Competitive Wages & Family Benefits:
    • Competitive wages
    • Parental leave (4 weeks paid)
    • Housing programs
    • Childcare reimbursement
  • Comprehensive Health Benefits:
    • Medical
    • Dental
    • Vision
  • Educational Programs:
    • Tuition Assistance
    • Existing Student Loan Repayment
    • Specialty Certification Reimbursement
    • Annual Supplemental Educational Funds
  • Paid Time Off:
    • Roughly five weeks in your first year of employment and continues to grow each year.
  • Retirement & Supplemental Insurance:
    • 403(b) Retirement plan with immediate matching
    • Life insurance
    • Short and long-term disability
  • Recreation Benefits, Wellness & More:
    • $1,000 annual wellbeing reimbursement
    • Recreation discounts
    • Pet insurance
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