Case Manager

Current Employees

If you are a current Monument Health employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage. Primary Location Rapid City, SD USA Department RCH Care Management Scheduled Weekly Hours 0 Starting Pay Rate Range $35.20 - $44.00 (Determined by the knowledge, skills, and experience of the applicant.) Job Summary It starts with heart. That is what you will do each day. As a Case Manager at Monument Health, you will be valued as an essential team member providing compassionate patient focused care. You will discover a culture of teamwork, professionalism, mutual respect, and— most importantly— a life-changing career. You will make a difference. Every day.

As a Case Manager, you will be responsible for the collaboration of medical staff, patients, family, and the Healthcare team by assessing, facilitating, planning, and advocating for the health needs of a patient resulting in quality, cost-effective outcomes. You will establish goals and priorities consistent with the mission and goals of Monument Health as well as work to meet the individualized plan of care for the patients of our communities.

Job Description

Essential Functions: Coordination of services for hospitalized patients whose care needs range from observation level of care to emergent/urgent higher level of care transitions to include facilitation of payer authorization and transportation. Patient triage for hospitalized patients to ensure transitions to other appropriate settings which range from post-acute care to acute care transitions. Uses critical thinking skills to assist providers in establishing plan of care recommendations for hospitalized patients. Partners with providers and Physician Advisors/Medical Directors to escalate cases for review on complex cases in compliance with Conditions or Participation and Escalation standards. Coordinates the provider aspect of federal/state organization functions as detailed in the Conditions of Participation and other appropriate regulations. Supports compliance with Utilization Review and regulatory guidelines. Identify trends related to compliance of regulations and collaborates with appropriate hospital personnel and external agencies to ensure appropriate process changes are implemented. Supports the Medical Staff Quality Review process by identification of issues related to quality indicators set forth by the Medical Staff. Creates and updates the Plan of Care (POC) to include patient/family-centered goals with interventions that reflect the changing needs of the patient/family unit and is consistent with their current needs and desires. Maintains a working knowledge and relationship with community resources and payer benefits that link the individual with the most appropriate resources. Assists by maintaining expertise on benefits, reimbursement and contract/regulation changes per payer guidelines, Medicare and Medicaid to facilitate appropriate reimbursement, education and guidance to assist the Healthcare team and patient/family in decision making. Facilitates planning for patient/family needs to ensure a smooth transition for the patient across the continuum of care to include offering guidance to patients / families regarding applications for funding, guardianship and charity care programs as needed. Evaluates current treatment plan to identify barriers, determine realistic goals and objectives, and seek potential alternatives in conjunction with the medical staff. Coordinates team efforts with support services departments to ensure appropriate care and smooth discharge transition. Is a visible resource on the unit and coordinates interdisciplinary team huddles/communication, identifying and communicating the patient’s Healthcare needs based on the best practice standards to ensure care and communication needs are met in relation to both internal and external providers/services, ancillary department services, core measures, compliance with internal policies/regulatory guidelines and True North metrics. Performs follow-up phone calls to patients within 48 hours of discharge and triages patients/family calls up to the first outpatient follow-up visit. Confirms follow up appointments are made and coordinates further communication/clarification with providers as indicated. All other duties as assigned. Additional Requirements Required: Education - Completion of a nursing education program that is approved by a board of nursing Certification - Registered Nurse (RN) - South Dakota Board of Nursing Preferred: Education - Bachelors in Business or Nursing Experience - 2+ years of Acute Experience; 2+ years of Registered Nurse Experience Certification - Commission for Case Management Certification (CCMC) - Accredited University or accredited training professionals Physical Requirements: Medium work - Exerting up to 50 pounds of force occasionally, and/or up to 30 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects. Job Category Patient Services Job Family Care Coordination Shift Requires the ability to work assigned schedules and hours as determined by the department Employee Type PRN