The Case Manager Assistant supports the Utilization Review team by assessing patient social needs, coordinating safe discharge plans, and managing insurance authorizations. They also perform clinical reviews to ensure medical necessity and maintain accurate documentation within the hospital's electronic systems.
Requirements summary
Candidates must be a Licensed Practical Nurse (LPN) with a current state license. Three to five years of acute care experience and familiarity with insurance guidelines and discharge planning are preferred.
Under the leadership of the Director of Case Management, the Case Manager Assistant will function as an active member of the CM/ Utilization Review team.
In their role as the Case Manager Assistant, one will be assessing, preparing and assisting patients in meeting the social needs of the patient in addition to the discharge process, as needed.
The Case Manager Assistant will deliver professional services consistent with the strategic vision, goals, philosophy and direction of the Utilization Review Department and Crisp Regional Hospital.
The Case Manager Assistant provides ongoing support and expertise that ensures that multiple services need of the patient upon discharge are met.
The Social Worker Discharge Planner monitors services delivered to selected patient populations during the acute hospital stay and promotes effective utilization of resources.
Basic Qualifications
• Education:
Requires a Licensed Practice Nurse • Experience
Three to five years varied acute care experience or comparable job-related experience, preferred.
Basic understanding of Medicare/Medicaid, Commercial insurance and regulatory guidelines preferred.
Experience in social services, discharge planning, utilization management or care coordination preferred.
Licensure, Registrations & Certifications:
Requires and maintains current state license as a Licensed Practical Nurse
Essential Job Responsibilities
Assist in conducting assessments and developing safe discharge disposition.
Coordinate and collaborate with interdisciplinary teams, community agencies, patients, and families to ensure timely, safe, and effective discharge planning.
Participate in discharge planning and care transitions to post-acute settings as applicable to ensure plans align with clinical goals, patient preferences, and payer requirements.
Coordinate services across acute, post-acute, and community settings. Arrange community services, durable medical equipment, transportation, and follow-up care.
Provides referrals as indicated to the appropriate health care team member and/or post-acute service. Follow up on receipt of referrals.
Verify patient’s insurance information, report any discrepancies and follow up as required.
Obtains authorization number for new admissions when needed, documents number of days approved, next review date and level of care in the department utilization review documentation tool.
Coordinate and submit timely clinical reviews to payers.
Enter denials, assist in setting up peer to peer reviews and obtaining outcomes.
Assist in providing Choice, IMM and MOON forms.
Review clinical documentation to determine medical necessity and appropriate level of care using approved criteria (e.g., InterQual®, MCG®).
Conduct admission, continued stay, and concurrent reviews.
Ensure timely conversion between observation and inpatient status when indicated.
Assist with prevention of avoidable delays, extended length of stay, and readmissions.
Assist in entering documentation for rationale.
Support RN, UR and SW in obtaining patients forms in Cerner.
Documentation of all interventions per hospital/departmental policies.
Perform general clerical duties such as answering the phone, checking voicemail.
