The Case Manager coordinates utilization review functions to comply with hospital procedures and federal regulations. Ensures compliance with Medicare Conditions of Participation, as well federal and state regulations as it relates to utilization review and discharge planning. Functions as the liaison between payers and physicians to secure payment approvals/authorizations and prevent denials. The Case Manager communicates with payers regarding level of care at intervals required by payers. They are accountable for the entry, tracking and analysis of all Utilization Management Module data. Case Managers initiate patient notices as required, including Important Message from Medicare, Medicare Outpatient Observation Notice, Patient Choice and Notice of Non-Coverage. Actively participates in IDP rounds. Is responsible to assess, develop and implement discharge plans for the patient. Follows all Case Management and hospital policies and procedures.
Minimum Requirements: At least an Associate's degree, current WA State RN or LPN licensure and at least 2+ years' recent hospital experience.
About Trios Health
Trios Health, formerly Kennewick General Hospital, is a multi-faceted public healthcare system located in southeastern Washington, primarily serving the Tri-Cities—Kennewick, Pasco, and Richland—and surrounding communities. What began as a small hometown hospital founded by a dedicated legion of Kennewick residents over 60 years ago has grown with the community that built it.
Today, Trios Health is anchored by its new Trios Southridge Hospital and remains deeply connected to its community roots, but with the ability to offer a lifetime of care across a broad spectrum of healthcare specialties and services. In fact, we've built what has become one of Eastern Washington's largest multi-specialty medical groups. And we've been careful to weave a strong thread of human compassion through the fabric of our culture. The result is an array of complementary inpatient and outpatient services—provided by passionate, empathetic people—that combine to provide holistic medical care for patients facing a variety of health challenges.
Your total health—mind, body, and spirit—is our priority. Continuing to evolve so that we're ready with the right healthcare services, available and accessibl...e when your life calls for them, is our commitment to you, the community we call home.
A little more about us:
•Our medical staff includes over 300 providers.
•We have multiple outpatient specialty Care Centers throughout Kennewick, including two urgent care locations and Kennewick's only after-hours pediatric service.
•The new state-of-the-art Trios Southridge Hospital opened in 2014 to accommodate the area's expanding healthcare needs.
•The Trios Foundation enhances patient care through fundraising that supports new programs, services, and equipment.