Case Manager

Case Manager - Kansas Spine and Speciality Hospital

Department: Case Management

Reports to: Manager of Case Management

Hiring Now for Case Manager at Kansas Spine and Specialty Hospital

The Case Manager is responsible for the coordination of care and services for patients across the continuum of care in an acute care hospital setting. This role ensures appropriate resource utilization, facilitates safe and timely discharges, and supports patients and families in navigating the healthcare system. The Case Manager collaborates with physicians, nurses, social workers, and other healthcare team members to optimize patient outcomes, ensure quality of care, and meet regulatory and reimbursement requirements.

Essential Duties and Responsibilities

• Conducts comprehensive assessments of patients' medical, psychosocial, and financial needs upon admission and throughout hospitalization.
• Develops, implements, and updates individualized care plans in collaboration with the interdisciplinary team.
• Coordinates and facilitates discharge planning, including home health, skilled nursing, rehabilitation, hospice, or other post-acute services as appropriate.
• Serves as a liaison between patients, families, healthcare providers, and community resources to promote continuity of care.
• Monitors and evaluates the appropriateness of services and care plans, adjusting as patient needs evolve.
• Ensures compliance with all federal, state, and accreditation standards related to case management and discharge planning (e.g., CMS, The Joint Commission).
• Identifies barriers to care or discharge and works proactively with the care team to resolve issues.
• Provides patient and family education on care options, insurance coverage, and available resources.
• Participates in utilization review activities to ensure appropriate level of care and facilitate reimbursement.
• Maintains accurate, timely, and thorough documentation in the medical record according to hospital policies.
• Collaborates with quality improvement initiatives to enhance patient outcomes and hospital performance metrics.
• Conducts utilization reviews to assess appropriateness of admission, continued stay, and discharge planning.
• Collaborates with physicians and payers to address medical necessity or level of care concerns.
• Ensures all utilization review documentation meets hospital, payer, and regulatory requirements.

Qualifications

Education:

• Registered Nursing License required. Bachelor of Science in Nursing (BSN) degree preferred or Social Work degree (BSW or MSW) may be considered for certain case management roles.

Licensure/Certification:

• Current RN license in the state of practice required (or LMSW if social work-based).
• Case Management Certification (ACM, CCM) preferred or required within 2 years of hire.

Experience:

• Minimum of 3 years of clinical experience in acute care required.
• Prior experience in case management, discharge planning, or utilization review preferred.

Skills/Abilities:

• Strong communication, negotiation, and problem-solving skills.
• Ability to work collaboratively with multidisciplinary teams.
• Knowledge of healthcare regulations, insurance processes, and community resources.
• Proficiency in electronic medical records and Microsoft Office applications.

Physical and Working Conditions

Work is primarily performed in an acute care hospital setting with frequent interaction with patients, families, and staff. May require occasional lifting of light objects (up to 20 lbs) and extended periods of walking or standing.

Performance Expectations

• Demonstrates commitment to patient-centered care, quality, and safety.
• Meets departmental metrics for length of stay, readmission prevention, and discharge timeliness.
• Upholds confidentiality and ethical standards in all aspects of care coordination.