Case Manager-ED

We are seeking a Case Manager to support the patients and their families at Kingman Regional Medical Center, primarily within the ED, in‑patient, and pre‑access settings. The role coordinates care, conducts utilization review, and facilitates transition to community resources.

• Conducts assessment and evaluation of admitted patients for medical, physical, and psychological factors that may contribute to their disease process and may require specific or complex continuing care and/or supportive services.
• Reviews medical records concurrently and retrospectively as necessary to assess the management of cases by comparing progress to predetermined criteria.
• Evaluates for medical necessity, level of care, coverage issues, appropriate utilization of resources, and planning by reviewing physician documentation to ensure that MCG criteria is met.
• Collaborates with members of the healthcare team concerning patient’s assessment, goals, care plan and progress.
• Performs ongoing assessments of patients for continuing care needs such as Skilled Nursing Facilities, acute Long Term Care Facilities, Durable Medical Equipment, and Home Health.

• Participates in Multidisciplinary Rounds (MDR) to assist with the development of care plans that will meet the patient’s current and continuing healthcare needs.
• Serves as an advocate for the patient and protects patient rights as they pertain to the ethical and legal issues of confidentiality during the case management process.
• Based on patient assessment, develops a discharge plan, per KHI’s Discharge Planning policy, to coordinate the provision of goods and services with referrals to specific providers, and ensures initial implementation of the discharge plan in collaboration with the Discharge Care Coordinator.
• Based on patient’s assessment and collaboration with the healthcare team, and the patient/family, the Case Manager develops and documents the discharge plan by identifying the needs of the patient and the availability of resources to ensure a safe transition from the hospital. The Case Manager assists patients and their families with needs such as complex discharge planning needs, suspected emotional, cognitive, or mental problems, financial issues, and home/environmental issues.
  
  When identified, refers all suspected child and elder abuse/neglect concern to the appropriate agency.
• Participates in MDR to ensure effective communication and collaboration for patients identified as having complex needs.

• When necessary, determines which cases will require medical staff review and/or UR management intervention based upon KHI’s Utilization Management Plan. Factors such as cost/benefit, appropriateness, availability of resources, quality, prior authorization requirements, and patient choice are taken into consideration during the case management process.
• Communicates with the attending physician, expected length of stay, Medicare guidelines and individual variances.
• Proficiently utilizes MCG and applies clinical guidelines and criteria appropriately to make utilization determinations. Inputs data into MCG when needed. Communicates frequently with the UR Nurse and provides requested data timely.

• Participates in committees, performance improvement activities, mandatory in‑services, and continuing education.
• Maintains compliance with established hospital policies, procedures, objectives, safety, environmental and infection control guidelines.

• Completes initial UR review on 100% of patients admitted during scheduled shift and completes all data entry into required documentation tools prior to end of shift.
• Assists with appropriate compliance of regulatory requirements, both State and Federal, including delivery of Hospital Initiated Notices of Non‑coverage (HINN).
• Reviews non‑emergent transfers into the hospital for medical necessity of admission.
• Provides physicians with alternatives to admission when patients do not meet medical necessity guidelines for admission to the facility.

• Reviews surgery and OP procedure schedules to verify…