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At Novant Health, one of our core values is diversity and inclusion. By engaging the strengths and talents of each team member, we ensure a strong organization capable of providing remarkable healthcare to our patients, families and communities. Therefore, we invite applicants from all group dynamics to apply to our exciting career opportunities.
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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 Hilton Head Hospital
Hilton Head Hospital Hilton Head Hospital (HHH) is a 93-bed acute care hospital located at 25 Hospital Center Boulevard in Hilton Head Island, SC. HHH serves Hilton Head Island, Bluffton, Okatie and surrounding counties through its care team of over 600 colleagues and over 100 physicians. The hospital provides a continuum of services through its centers and programs, including a 24-hour emergency department, critical care, cardiac care ranging from minimally invasive to open heart surgery, obstetrics/ gynecology, urology, a nationally accredited breast health center, spine care, gastroenterology, surgical services, cardiac and physical rehabilitation.

MARKET CASE MANAGER I FULL TIME 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 FULL TIME 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.

Novant Health is an equal opportunity employer and conducts all human resource practices in compliance with federal, state and local civil rights and employment legislation. Accordingly, Novant Health considers all applicants for employment equally, without regard to race, color, religion, sex, national origin, age, disability, veteran’s status, marital status, sexual orientation, gender identity or expression and provides them with an opportunity to progress in the organization consistent with their skills and interests

Please refer the Job description for details