Lead Case Manager

About the Team

Monument Health is dedicated to making a difference every day through clinically based care management. Our Care Management department operates within the acute care hospital setting in Rapid City, SD, focusing on delivering effective, efficient, and patient-centered care. The team collaborates closely with medical staff, patients, families, and the broader healthcare ecosystem to ensure quality, cost-effective outcomes that align with the organization's mission and regulatory standards.

About the Role

This position serves as a vital resource for the interdisciplinary team, providing clinically based care management to support the delivery of high-quality care. You will be responsible for assessing, facilitating, planning, and advocating for the health needs of individual patients and their families. Your day-to-day work involves determining realistic goals, coordinating efforts for smooth discharge planning, and ensuring clear follow-up after discharge.

A key aspect of this role is utilizing InterQual criteria guidelines to confirm medical necessity for admission and continued stays. You will act as a visible resource on the unit, coordinating interdisciplinary team huddles to communicate patient needs based on best practice standards. This includes creating and updating Plans of Care that reflect the changing needs and desires of the patient and family unit, while ensuring compliance with federal, state, and local regulatory bodies such as JCAHO.

Hiring Process

Current employees are invited to apply for this opportunity by logging into their Workday Account via the internal career site and clicking the "Career" icon on their homepage.

Our Culture & Commitment

Monument Health fosters a supportive work culture that values growth, offering opportunities for advancement and flexible scheduling. We are committed to diversity and inclusion as an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.

Work location

Work model: On-site

143rd Avenue, Rapid City, Pennington County, South Dakota, 57701, United States

Rapid City, South Dakota

Key Responsibilities

check_circleApply reimbursement procedures and managed care contracts to facilitate the plan of care
check_circleSupport compliance with Utilization Review and regulatory guidelines by identifying trends
check_circleCreate and update patient/family-centered Plans of Care with appropriate interventions
check_circleMaintain knowledge of community resources and payer benefits to assist with reimbursement
check_circleEvaluate treatment plans to identify barriers and determine realistic goals with medical staff
check_circleFacilitate planning for patient needs to ensure smooth transitions across the continuum of care
check_circleCoordinate interdisciplinary team huddles to communicate patient health care needs
check_circleCoordinate provider aspects of federal and state organization functions per regulatory requirements

Requirements

verifiedCompletion of nursing education program approved by board of nursing or Bachelors/Masters in Social Services
verifiedRegistered Nurse (RN) license - South Dakota Board of Nursing or Certified Social Work (CSW) - South Dakota Department of Social Services
verified2+ years Acute Experience and 2+ years Registered Nurse Experience (or 3+ years Healthcare related Experience for Social Services)
verifiedCommission for Case Management Certification (CCMC) preferred

Nice to Have

Bachelor's degree in Nursing. 2+ years of acute care experience. 2+ years of Registered Nurse experience (or 3+ years of healthcare-related experience for Social Services). Commission for Case Management Certification (CCMC).

Benefits & Perks

check_circleMedical, Vision and Dental Coveragecheck_circleRetirement Plans, Health Savings Account, and Flexible Spending Accountcheck_circlePaid Time Off Accrual Bankcheck_circleTuition assistance/reimbursementInstant pay is available for qualifying positions

Skills, education and keywords

Skills: Interqual Criteria, Jcaho, Utilization Review, Medicare, Medicaid, Registered Nurse, Certified Social Work, Commission For Case Management Certification.

Education: Bachelors in Nursing preferred; Bachelors Degree in Social Services required; Masters Degree in Social Services required.

Frequently asked questions about Lead Case Manager at Monument Health

What does a Lead Case Manager at Monument Health do?expand_more

In this Lead Case Manager at Monument Health role, you will apply reimbursement procedures and managed care contracts to facilitate the plan of care; support compliance with utilization review and regulatory guidelines by identifying trends; create and update patient/family-centered plans of care with appropriate interventions; and maintain knowledge of community resources and payer benefits to assist with reimbursement.

What are the requirements for this Lead Case Manager role?expand_more

Monument Health is looking for candidates who meet the following requirements: Completion of nursing education program approved by board of nursing or Bachelors/Masters in Social Services; Registered Nurse (RN) license - South Dakota Board of Nursing or Certified Social Work (CSW) - South Dakota Department of Social Services; 2+ years Acute Experience and 2+ years Registered Nurse Experience (or 3+ years Healthcare related Experience for Social Services); and Commission for Case Management Certification (CCMC) preferred.

Where is the Lead Case Manager role at Monument Health located?expand_more

Lead Case Manager at Monument Health is based in 143rd Avenue, Rapid City, Pennington County, South Dakota, 57701, United States. This is a on-site role.

Is this Lead Case Manager job remote, hybrid, or on-site?expand_more

Monument Health has listed this Lead Case Manager role as on-site.

How much experience is required for this Lead Case Manager role?expand_more

Lead Case Manager at Monument Health typically requires 2+ years of relevant experience at the mid level level.

What skills do you need for the Lead Case Manager role at Monument Health?expand_more

Key skills for Lead Case Manager at Monument Health include Interqual Criteria; Jcaho; Utilization Review; Medicare; Medicaid; Registered Nurse; Certified Social Work; and Commission For Case Management Certification.

What education is required for Lead Case Manager at Monument Health?expand_more

Educational requirements for this role: Bachelors in Nursing preferred; Bachelors Degree in Social Services required; and Masters Degree in Social Services required.

What category does the Lead Case Manager role belong to?expand_more

Lead Case Manager at Monument Health is part of the healthcare & nursing job category on Recrutus.