Case Manager RN- Full-Time
Job description may be revised in writing to add or delete duties
at any time at the discretion of management.
Health Services, Inc. (UHS) is one of the nation’s largest and
most respected health care management companies, operating through
its subsidiaries acute care hospitals, behavioral health facilities
and ambulatory centers nationwide. Founded in 1978, UHS subsidiaries
now have more than 65,000 employees. The UHS business strategy is to
build or purchase health care properties in rapidly growing markets
and create a strong franchise based on exceptional service and
effective cost control. Our success comes from a responsive
management style and a service philosophy based on integrity,
competence and compassion.
As a representative of Springwoods Behavioral Health, all comments,
attitudes, actions, and behaviors have a direct effect on the
Facility’s image and perceptions of quality service.
Interaction with patients, family members, physicians, referral
sources, affiliating schools, visitors, etc. must be in a manner that
is friendly, supportive, courteous, respectful, cooperative, and
professional. This behavior should promote an atmosphere of teamwork,
which is congruent with facility standards and guidelines to promote
Position Purpose: The Case Manager,
RN coordinates the design, development, implementation, and
monitoring of Springwoods Behavioral Health’s case management
and utilization review functions. The Case Manager will achieve the
goals of clinical, financial and utilization as set forth in the UR
plan by effective management and communication. The Case Manager
functions as the internal resource on issues related to the
appropriate utilization of resources, coordination of care across the
continuum and utilization review. The Case Manager is responsible for
carrying out assignments in a manner to assure success in financial
management, quality and operational management objectives. The Case
Manager participates in program development and unit performance
improvement. The Case Manager consistently demonstrates the core
values and mission statement of Springwoods Behavioral Health.
Position Reports To:
Director of Case Management
Position Supervises: None
• Completes daily reviews
on all patients and oversees the completion of those reviews to all
requesting insurance companies per contract agreement.
Receives all denials for care involving patient stays, discusses with
medical team feasibility to appeal. Manages all appeals related to
denials of patient stays for all payors/insurance companies.
• Participates in quality improvement processes and assures
implementation of regulatory standards.
• Ensures service
is provided considering the age-specific physiological, emotional and
cognitive needs of the patients served.
• Acts as a
liaison between the patient/family, physician and patient care team
as necessary to problem solve.
• Guides staff in the
adherence to applicable standards of care/practice and/or
evaluates, and monitors case management processes, policies and
procedures to ensure that appropriate Hospital resource utilization
• Services as an internal resource and
consultant to management, medical staff about case management,
reimbursement, clinical resource utilization and care coordination
• Minimum of 5 years of recent
clinical experience preferred
• Experience in acute
clinical case management and/or utilization review preferred
• Experience in related duties in the delivery of patient
care, management of patient care providers or project management in a
healthcare environment preferred
• Current licensure in
good standing with the Arkansas Board of Nursing as a Registered
• Current BLS/AED or the ability to obtain it
within 90 days from the date of hire.
• CPHM, CCM or ACM
SKILLS, ABILITIES AND COMPETENCIES:
• Current knowledge of case management, care coordination and
utilization review processes.
• Knowledge of or the
ability to learn financial management related to UR function and
reporting quality and improvement processes.
• Ability to
effectively monitor, evaluate and administer the resources of each
assigned area and make substantial recommendations regarding resource
allocation needs for future planning.
• Ability to
effectively communicate in writing and verbally
to analyze information and problem solve.
evidence of strong skills in confidentiality, integrity, creativity
• Demonstrates the ability to interact
with a wide variety of individuals and handle complex and
confidential sensitive situations.
• Proficient in the use
of computer and multiple software programs.
• Ability to
perform utilization review, assist and coordinate appeal efforts in a