Case Manager

Experienced case manager with 5+ years in an acute hospital setting. Responsibilities include performing and documenting patient assessments within 24 hours of admission, coordinating prior authorizations, navigating payer portals, conducting concurrent reviews, and communicating with HMOs to obtain insurance authorization. Develops and implements plans of care from admission to discharge, determines appropriate levels of care using Milliman Care and Interqual Guidelines, and promotes cost-effective, evidence-based practice. Skills include proficiency with Medhost EMR, strong communication with medical staff, regulatory knowledge, and the ability to educate patients and families about discharge planning and available resources. Includes facilitating transfer procedures, guardianship management, discharge planning education, PI program participation, and proactive denial prevention through payer collaboration. Shift details and budgeted hours are noted as not included.