Lead Case Manager
Not Disclosed•Full-TimeOn-site
location_on143rd Avenue, Rapid City, Pennington County, South Dakota, 57701, United States
About the Team
Monument Health is dedicated to making a difference every day through clinically based care management. Our mission is to support the delivery of effective, efficient, and patient-centered care within the acute care hospital setting. The Care Management department works to ensure quality, cost-effective outcomes by collaborating closely with medical staff, patients, families, and the broader healthcare team.
About the Role
This position serves as a vital resource on the unit, assessing, facilitating, planning, and advocating for individual health needs. You will determine realistic goals and coordinate efforts to ensure smooth discharge planning and clear follow-up after discharge. A key part of this role involves utilizing InterQual criteria guidelines to confirm medical necessity for admission and continued stays, while establishing priorities consistent with the mission of Monument Health.
You will act as a visible liaison between the hospital and the community, maintaining expertise on benefits, reimbursement, and regulatory changes to assist the healthcare team and patients in decision-making. By coordinating interdisciplinary team huddles and communicating patient needs based on best practice standards, you will help ensure care and communication needs are met across internal and external providers, ancillary departments, and regulatory bodies like JCAHO.
Hiring Process
Current Employees: If you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.
External Applicants: Qualified applicants will be considered for this role in Rapid City, SD. The interview process typically involves reviewing qualifications against the required nursing or social work certifications and relevant acute care experience.
Equal Opportunity
Monument Health is 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_circleCreate and update patient/family-centered Plans of Care with appropriate interventions
- check_circleMaintain knowledge of community resources and payer benefits to assist with decision making
- check_circleEvaluate treatment plans to identify barriers and coordinate team efforts for discharge
- check_circleFacilitate planning for patient needs to ensure smooth transitions across the continuum of care
- check_circleSupport compliance with Utilization Review and regulatory guidelines while identifying trends
- check_circleCoordinate provider aspects of federal and state organization functions per Conditions of Participation
- check_circleCoordinate interdisciplinary team huddles to communicate patient health care needs
Requirements
- verifiedCompletion of nursing education program approved by board of nursing or Bachelors/Masters Degree 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 of Acute Experience and 2+ years of Registered Nurse Experience OR 3+ years of 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
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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; create and update patient/family-centered plans of care with appropriate interventions; maintain knowledge of community resources and payer benefits to assist with decision making; and evaluate treatment plans to identify barriers and coordinate team efforts for discharge.
What are the requirements for this Lead Case Manager role?expand_more
To qualify for the Lead Case Manager at Monument Health position, applicants should have: Completion of nursing education program approved by board of nursing or Bachelors/Masters Degree 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 of Acute Experience and 2+ years of Registered Nurse Experience OR 3+ years of 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 lead 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.