Position Summary A Brief OverviewPromotes and facilitates effective use of hospital resources. Assists with planning an individual comprehensive case management plan addressing patient/family needs and transition to the next appropriate level of care. This is a part time position; Mon- Tues- Weds 8am-430pm. At Baptist Health, our mission is to improve the health and quality of life for the individuals and communities we serve. Baptist Health Brookwood Hospital offers great NEW competitive pay and benefits! • Medical, Dental, Vision • 403(b) Retirement Savings Plan w/matching • Health Savings Account (HSA) • Flexible Spending Account (FSA) • Paid Time Off (up to 5 weeks to start) • Life Insurance • Extended Leave Plan (ELP) • Family Care (childcare, elder care, pet care) • Educational Benefits including tuition reimbursement & monthly payments to help pay down any graduated school debt ALL benefits start on day one! Our people are passionate about what they do, the product they sell, and the customers they serve. If you're looking for an opportunity to be a part of a work family that values collaboration, innovation and dedication, we're the right company for you.Section 1557 Non-DiscriminationThe Office for Civil Rights (OCR) enforces Section 1557 of the Affordable Care Act (Section 1557), which prohibits discrimination on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. 42 U.S.C. 18116.Company is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities. Responsibilities • Initially and concurrently assesses all patients within assigned population to include but not limited to admitting diagnosis/medical history, current treatments/therapies, age, payment source, criteria compliance, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/personal needs, and other relevant information. • Assigns working DRG and GMLOS, while concurrently monitoring and managing LOS, as appropriate (determined by medical necessity using Interqual guidelines). • Develops collaborative relationships with patient/family, patient business, nursing staff/leadership, physicians, social workers, care coordinators, and ancillary services to facilitate optimal patient outcomes and efficient movement through the continuum of care. • Prioritizes activities in assigned areas to focus on high risk, high cost, and problem prone areas. • Acts as an advocate for patient’s health care needs. • Performs admission and concurrent utilization review in compliance with review requirements for Managed Care contracts, governmental payors (i.e. Medicare, Medicaid, and Champus) and departmental review policies; adheres to Utilization Management Plan. • Communicates in an appropriate and timely manner with interdisciplinary team to coordinate/evaluate plan of care. • Communicates with third party payers and external care team as appropriate/necessary. • Monitors and evaluates data, fiscal outcomes, and other relevant information to develop and implement strategies for process improvements related to case management activities. • Maintains positive relationships with peers, collaborative team, outside reviewers, and post-acute providers. • Maintains reasonably regular, punctual attendance consistent with Baptist Health policies, the ADA, FMLA, and other federal, state, and local standards. • Maintains compliance with all Baptist Health policies and procedures. • Demonstrates awareness of medical/ legal issues, patient rights and compliance with standards of regulatory and accrediting agencies. • Serves as a facilitator to physician, nursing staff/leadership and ancillary services (physical therapy, respiratory therapy, clinical social work, care coordination, etc.). • Maintains records and documentation of work performed in a timely, organized, and easily retrievable fashion. • Reviews current literature on a regular basis; stays current on changes in policies/procedures, maintains reference materials and updates as required, and keeps abreast of relevant reimbursement information. • Assumes responsibility as a self-directed professional for ongoing education, based on individual identified needs. • Actively serves on committees and task force teams to promote quality, cost-effective care for patient population. • Maintains positive relationships with outside reviewers and other payer representatives. • Forwards identified quality and/or risk issues to appropriate person. Qualifications • Diploma For Team Members hired into this job prior to January 1, 2020: Completion of an accredited RN education/training program Required • Bachelor of Science in Nursing degree (BSN) within 36 months of placement Required • 3 Years of experience in chronic disease management, case management, utilization management, or acute clinical care Required • Maintains license as an RN in the State of Alabama. • Maintains current BLS/ healthcare provider certification.