Case Management/Quality Coordinator Full-time


Acute Care


Position Summary:

This position will involve several aspects:  
Utilization Review: Conducts review of admissions for medical necessity and utilization of services to ensure the appropriate level of patient care. Determines appropriate level of patient care with the use of Milliman’s web-based system and through collaboration with providers. Reviews, monitors, evaluates, and coordinates patient’s stay to assure services are timely and efficient. Maintains appropriate documentation.
Discharge Planning: Assesses patient needs and makes arrangements for any medical equipment, home care services, or follow-up appointments that may be required for a patient upon discharge. Go over medications and perform discharge follow-up calls to patients.
Pre-Authorizations: Works with insurance carriers to ensure coverage of all medical equipment and post-discharge services that may be required. Obtain authorization from insurance carriers for outpatient services that require prior authorization.
Quality Assurance: Coordinates all aspects of quality monitoring, evaluation, improvement and assessment. Assists personnel with an integrated quality evaluation and management program. Communicates with surveyors regarding quality monitoring.
Infection Control: Implements and directs a facility wide infection control program. Responsibilities include but not limited to surveillance, analysis, reporting and recording activities as well as setting standards and evaluating compliance for practices that are associated with the prevention and control of health care associated infections. Conducts the patient real time surveys. Responsible for HCAHPS file submission and directing the survey results to the CEO for communication of the results to Governing Board and staff.

Reports to:

Acute Care Director of Nursing

Candidates who meet these qualifications, and are interested in this position should get an application from Vanessa, complete, and return. If more information is needed please contact Tammy RN, Interim DON or Regan RN, DON.



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