Case Manager LPN

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• Utilize Interqual Criteria to assure the appropriate level of care is determined in order to receive appropriate third party payer authorizations with required time frames. Based on direction from the Case Manager, will continue to provide clinical support in communication to third party payers throughout the patient stay. Will provide preparation of the daily work for the Case Manager as appropriate.
  
  Will provide coordination of physician communication to streamline daily contact.
• Assist in managing the continuum of care from admission through discharge. In collaboration with Social Services, will facilitate cost effective/appropriate management of patient cases or discharge planning, medication authorization and other home/transfer needs based on the patient's plan of care. Assist Case Manager to obtain authorization for post-acute care services including SNF, DME and Home Health Care.
• Participate in patient care conferences, daily rounds and family conferences as directed by the Case Manager.
• Assist Case Manager with problematic cases and patient care issues required research and fact finding.
• Audit inpatient Case Management for appropriate documentation including admit orders, length of stay certification and documentation medical necessity.
• Collect quality and utilization data as assigned by management personnel and Appeals Specialists.
• Assist with preparation of materials related to teleconferences, readmission reviews, denials and appeals.
• Maintain education and licensing requirements as determined by the Director of Case Management.
• Additional duties as assigned.

Education, Certification, and/or Licensure:

• Current Licensed Practical Nurse license issued by the state in which services will be provided or current multi-state Licensed Practical Nurse license through the enhanced Nurse Licensure Compact (eNLC).

Preferred Qualifications:

• Two (2) years clinical experience in the acute care setting.

• Frequent sitting, standing, walking, reaching.
• Ability to lift and carry up to 10 pounds.

• Working closely with others.
• Working around biohazards and infectious diseases.
• Working with electrical hazards associated with patient care equipment.

• Knowledge of insurance and authorization processes.
• Knowledge of patient discharge needs and local community resources.
• Knowledge of patient’s current medical insurance coverage and limitations and the precertification requirements for Durable Medical Equipment (DME), post-acute placements, infusions, transfers etc.

Scheduled Weekly

Hours:

40

Exempt/Non-Exempt:
United States of America (Non-Exempt)

Shift: Non-Exempt

Company: WH Wheeling Hospital Inc.

Address: 1 Medical Park Drive, Wheeling, West Virginia

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law.

All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.