Case Management Specialist

It is Hemphill County Hospital District's mission to serve the region's health needs through exceptional care in a compassionate environment by dedicated professionals. Our focus is on relationships and community-centered healthcare-- all aimed at improving the overall health, wellness, and quality of life of our neighbors.
 We believe every role has an impact on our patients lives, and you have the opportunity to make a difference. We recognize and support each individual's unique talents and skills in a collaborative atmosphere. We are looking for a dedicated professional like you to be a part of our HCHD team as a Full Time Case Management Specialist

Join us in our efforts as we better serve our community!

Summary:

Primary responsibilities include coordinating inpatient and swing bed services, coordinating outpatient services, utilization review, liaison with payers, scheduling of services and referral follow through within the interdisciplinary team.

Essential Duties and Responsibilities of the Case Manager include: 

• Focuses on medical services provided by the Emergency Department care team members to patients to determine the case management needs of the patient from inpatient to outpatient services. 
• Identifies needs to facilitate quality care delivery.  
• Communicates and negotiates with insurance based on the needs of the patient. 

• Evaluate patients and identify appropriate level of care using Milliman Care Guidelines or Interqual Review Manager to establish Medical Necessity.  
• Utilizes sound knowledge base for decision making and establishing priorities of patient care.  
• Recommends the observation and inpatient admission process. 
• Coordinate referrals and appointments for outpatient services and community resources. 
• Utilization review is performed by evaluating the effectiveness of care given by health care team members, including self, as reflected in the documentation of patient’s progress/responses, communication skills and problem identification and resolution.   

• Follows transfers and referrals outside the system to ensure care services are directed back to the healthcare system. 
• Performs follow up calls on patients seen in the Emergency Department.   
• Participates in IDT meetings and business office/case management meetings.  
• Performs coverage for inpatient and swing bed case management when current case manager is absent. 
• Assists providers and staff with difficult patient psychosocial situations. 

• Maintains documentation on case management activities. 
• Other duties as assigned.

OTHER SIGNIFICANT REQUIREMENTS:

-Maintains confidentiality while working with confidential matters on a daily basis.

-Maintains continuous relationships with physicians, patients and family members.

-Follows aseptic procedures and precautions when involved in direct patient

  contact or handling potentially infectious materials.

-Attends educational in-services and staff meetings as required.

-Follows safety guidelines and policies for the Hospital District.

-This position reports directly to Nursing Case Management Coordinator

Education/ Certifications/ Licenses Requirements:

• Education in healthcare, marketing, social services, or a related field is preferred. 
• BLS certification required.
  
  

Minimum Experience, Abilities Required and Special Requirements:
- Minimum of two years experience in health care or related field, demonstrating organization and communication skills. 

- The employee must possess basic working knowledge of computers, and be able to enter necessary data into a computer.

Company Policy:

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.