RN Lead Case Manager Utilization Review FT Days

About Hilton Head Regional Healthcare 
Hilton Head Regional Healthcare provides comprehensive healthcare to the Lowcountry at four locations including Coastal Carolina Hospital, Hilton Head Hospital, the Bluffton Medical Campus and the Bluffton-Okatie Outpatient Center. Coastal Carolina Hospital (CCH) is a 41-bed acute care hospital located in Hardeeville, S.C., serving the medical and healthcare needs of Jasper and Beaufort counties since November 2004. Hilton Head Hospital (HHH) is a 109-bed acute care  hospital located on Hilton Head Island, S.C. Opened in 1974, HHH serves Hilton Head Island, Bluffton, Okatie and surrounding counties. All facilities are owned and operated by Dallas-based Tenet Healthcare Corp. Both hospitals are accredited by The Joint Commission, the nation’s oldest and largest hospital accreditation agency. Learn more about Hilton Head Regional Healthcare at www.hiltonheadregional.com.

About Hilton Head Hospital
Hilton Head Hospital (HHH) is a 109-bed acute care hospital located at 25 Hospital Center Boulevard in Hilton Head Island, SC.  Opened in 1974, HHH serves Hilton Head Island, Bluffton, Okatie and surrounding counties through its care team of over 600 colleagues and over 100 physicians.  The hospital provides a continuum of services through its centers and programs, including a 24-hour emergency department, critical care, cardiac care ranging from minimally invasive to open heart surgery, obstetrics/gynecology, urology, a nationally accredited breast health center, spine care, gastroenterology, surgical services, cardiac and physical rehabilitation, and a 12-bed geriatric psychiatric inpatient unit.  To learn more about Hilton Head Hospital, please visit www.hiltonheadregional.com.

RN Lead Case Manager Utilization Review Full Time Days Position Summary

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge, and prevent avoidable readmissions. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention, and patient satisfaction; Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care; Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; Education provided to physicians, patients, families and caregivers.

Responsibilities

Coordination of clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post-acute care) compared to evidenced-based practice, internal and external requirements. Educates and mentors new RN staff 

THE RN LEAD CASE MANAGER UTILIZATION REVIEW FULL TIME DAYS CANDIDATE WILL POSSESS THE FOLLOWING EDUCATION, LICENSE/CERTIFICATIONS, AND EXPERIENCE.

Experience

Required: 3 years of department experience or 4 years of acute hospital case management experience. 

Education

Required: Graduate of an accredited school of nursing. Preferred: Academic degree in nursing (bachelor's or master's)

Certification 

Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered. Preferred: Accredited Case Manager (ACM)
 

The individual’s responsibilities include the following activities:
a) accurate medical necessity screening and submission for Physician Advisor review,
b) care coordination,
c) transition planning assessment and reassessment,
d) implementation or oversight of implementation of the transition plan,
e) leading and facilitating multi-disciplinary patient care conferences,
f) managing concurrent disputes,
g) making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services,
I) communicating with patients and families about the plan of care,
j) collaborating with physicians, office staff and ancillary departments,
k) leading an