Department: Utilization Management
Shift: Per Diem, Day Shift (8:00 AM – 4:30 PM)

The Per Diem Case Manager is responsible for overseeing the quality and resource management of patients admitted to the facility, from the point of admission throughout their healthcare journey. Acting as a patient advocate, this role promotes cost containment, ensures quality care, and demonstrates leadership by collaborating with healthcare providers to achieve a seamless delivery of services. The Case Manager conducts holistic and comprehensive reviews of medical records, assessing medical necessity, intensity of service, and severity of illness to support optimal clinical and cost-effective outcomes.

• Manage patient care quality and resources from admission through discharge, ensuring continuity across the healthcare continuum.
• Serve as a patient advocate, promoting cost-effective care while maintaining high-quality clinical outcomes.
• Collaborate with multidisciplinary teams, including physicians, nurses, and ancillary providers, to facilitate seamless care delivery.
• Conduct comprehensive admission and concurrent reviews of medical records to determine medical necessity, severity of illness, and intensity of services provided.
• Monitor and evaluate patient care plans to ensure alignment with clinical standards and regulatory requirements.
• Facilitate utilization management, including prior authorizations, discharge planning, and coordination of post-acute services.
• Provide leadership in identifying opportunities to optimize resources and reduce unnecessary costs.
• Maintain up-to-date documentation in compliance with hospital policies, payer requirements, and legal standards.

Requirements:

1. Minimum 5 years of work experience post-graduation from an accredited school of nursing and a current state Registered Nurse (RN) license.
2. Minimum of five years acute care nursing experience.
3. At least one year of experience in case management, discharge planning, or nursing management.
4. Current BCLS (AHA) certificate.
5. Knowledge of Milliman Criteria and InterQual Criteria.
6. Experience and knowledge in basic to intermediate computer skills.
7. Behavioral Violence Prevention Training and maintain current.

At Landmark Medical Center, our dedicated team of professionals is committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, Landmark Medical Center is actively seeking new members to join its award-winning team!

Landmark Medical Center is a 214-bed acute care hospital in Woonsocket, RI. The hospital has been “A”rated for patient safety by The Leapfrog Group and has received numerous Healthgrades awards for patient safety excellence, heart care, and orthopedics. Originally known as the "Woonsocket Hospital," Landmark Medical Center has been serving the communities of northern Rhode Island and southern Massachusetts since 1873. Learn more at www.landmarkmedical.org.

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