A Case Manager at Johns Hopkins Medicine facilitates the coordination of care for patients with complex medical and psychosocial needs. This role focuses on ensuring seamless transitions between levels of care, optimizing resource utilization, and advocating for patient-centered outcomes within a world-class academic medical center.
Job Summary
The Case Manager is responsible for assessing, planning, implementing, and evaluating the transition of care for a designated patient population. Working as a key member of the multidisciplinary team, this position identifies barriers to discharge and develops comprehensive plans that address medical, financial, and social requirements. The role balances clinical necessity with fiscal responsibility while maintaining the highest standards of patient safety and satisfaction.
Key Responsibilities
- Performing initial and ongoing clinical assessments to identify patient needs and determine the most appropriate level of care.
- Developing and coordinating individualized discharge plans in collaboration with physicians, nurses, social workers, and families.
- Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as defined by insurance providers and regulatory agencies.
- Identifying and mitigating barriers to timely discharge, such as delays in testing, equipment procurement, or placement in post-acute facilities.
- Communicating regularly with third-party payers to obtain authorizations and provide clinical updates to ensure reimbursement.
- Arranging for home health services, durable medical equipment, and placement in skilled nursing or rehabilitation facilities.
- Providing education and support to patients and families regarding their care plan, community resources, and insurance benefits.
- Documenting all assessment findings, interventions, and transition plans in the electronic medical record with clinical precision.
- Participating in daily multidisciplinary rounds to provide updates on discharge status and care coordination efforts.
Qualifications and Requirements
- A valid and unencumbered Registered Nurse license in the state of Maryland or a recognized compact state.
- Bachelor of Science in Nursing (BSN) from an accredited program is typically required.
- Current Case Management Certification (CCM) or Accredited Case Manager (ACM) credential is highly preferred or must be obtained within a specified timeframe.
- Minimum of three years of clinical experience in an acute care setting; prior experience in case management or utilization review is strongly desired.
- Working knowledge of Milliman Care Guidelines (MCG) or InterQual criteria.
- Familiarity with Medicare, Medicaid, and private insurance regulations and reimbursement structures.
- Strong critical thinking, negotiation, and conflict-resolution skills.
- Excellent written and verbal communication skills for interacting with diverse medical teams and external agencies.
Working Conditions
- Work is primarily performed in an office or clinical unit setting within the hospital.
- Involves significant time spent on the telephone and utilizing computer systems for documentation and communication.
- Requires the ability to move between different units and buildings across the hospital campus.
- May involve high-stress situations when managing complex social cases or urgent discharge requirements.
Equal Opportunity Employer: ATC Healthcare Services is an Equal Opportunity Employer. All applicants will be considered for employment without regards to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status or any other category protected by Federal, State or local law. M/F/D/V EOE
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