Market Case Manager I Weekender PRN Days

About Hilton Head Regional Healthcare 
Hilton Head Regional Healthcare provides comprehensive healthcare to the Lowcountry at four locations including Coastal Carolina Hospital, Hilton Head Hospital, the Bluffton Medical Campus and the Bluffton-Okatie Outpatient Center. Coastal Carolina Hospital (CCH) is a 41-bed acute care hospital located in Hardeeville, S.C., serving the medical and healthcare needs of Jasper and Beaufort counties since November 2004. Hilton Head Hospital (HHH) is a 109-bed acute care  hospital located on Hilton Head Island, S.C. Opened in 1974, HHH serves Hilton Head Island, Bluffton, Okatie and surrounding counties. All facilities are owned and operated by Dallas-based Tenet Healthcare Corp. Both hospitals are accredited by The Joint Commission, the nation’s oldest and largest hospital accreditation agency. Learn more about Hilton Head Regional Healthcare at www.hiltonheadregional.com.

About Coastal Carolina Hospital
Coastal Carolina Hospital (CCH) is a 41-bed acute care hospital located at 1000 Medical Center Drive in Hardeeville, SC. Opened in 2004, CCH joined the healthcare system in 2007 and serves patients in Bluffton, Okatie, Hardeeville and surrounding counties through its care team of over 400 colleagues and over 70 physicians. The hospital provides many services to the community including a 24-hour emergency department, a dedicated Women’s Pavilion, and robotic-assisted minimally-invasive surgery. Coastal Carolina also has oversight of Tidewatch Emergency Department located in Okatie, SC which is the area’s first stand-alone emergency facility providing convenient care staffed by board-certified emergency medicine physicians, experienced nurses and support staff 24/7/365. To learn more about Coastal Carolina Hospital and Tidewatch Emergency Department, please visit www.hiltonheadregional.com.

Market Case Manager I Weekender PRN Days Position Summary:

The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:

· Utilization Management supporting medical necessity and denial prevention

· Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction

· Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care

· Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy

· Education provided to physicians, patients, families and caregivers

The individual’s responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) care coordination, c) transition planning assessment and reassessment, d) implementation or oversight of implementation of the transition plan, e) leading and facilitating multi-disciplinary patient care conferences, f) managing concurrent disputes, g) making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services, i) communicating with patients and families about the plan of care, j) collaborating with physicians, office staff and ancillary departments, k) leading and facilitating Complex Case Review, l) assuring patient education is completed to support post-acute needs , m) timely complete and concise documentation in Case Management system, n ) maintenance of accurate patient demographic and insurance information, o) identification and documentation of potentially avoidable days, p) identification and reporting over and underutilization, q) and other duties as assigned.

Market Case Manager I Weekender PRN Days Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other Qualifications

· Current license as a Registered Nurse in the State of South Carolina.

· BSN or MSN preferred.

· Minimum of three (3) years of hospital-based clinical experience preferred.

· Previous Case Management, Utilization Review or Discharge Planning experience desirable.

· Requires effective communication with patients, families, nursing, medical staff, and ancillary departments.

· Ability to take initiative to resolve problems immediately and implement change in a timely basis.

· Must be self-directed and able to adapt to change.

Hours: Saturday & Sunday - 8:00am-4:30pm (preferably 2 weekends a month)