Case Manager Utilization Review Nurse Jobs in Puerto Rico

Case Manager Career Opportunity

Recognized for your abilities as a Case Manager
Are you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on each patient's journey. As the leading provider of rehabilitation care in the nation, this opportunity allows you to leverage your clinical expertise while contributing to the well-being of individuals in your community. Manage resources, coordinate patient care from admission to post-discharge, and oversee interdisciplinary plan-of-care decisions. This is more than a career move; it's a chance to shape a future where care and compassion converge for truly meaningful outcomes.

A Glimpse into Our World
At Encompass Health, you'll experience the difference the moment you become a part of our team. Working with us means aligning with a rapidly growing national inpatient rehabilitation leader. We take pride in the growth opportunities we offer and how our team unites for the greater good of our patients. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For Award, among other accolades, which is nothing short of amazing.

Starting Perks and Benefits
At Encompass Health, we are committed to creating a supportive, inclusive, and caring environment where you can thrive. From day one, you will have access to:

• Affordable medical, dental, and vision plans for both full-time and part-time employees and their families.
• Generous paid time off that accrues over time.
• Opportunities for tuition reimbursement and continuous education.
• Company-matching 401(k) and employee stock purchase plans.
• Flexible spending and health savings accounts.
• A vibrant community of individuals passionate about the work they do!

Become the Case Manager you always wanted to be

• Work with interdisciplinary team, guiding treatment plans based on patient needs and preferences.
• Coordinate with interdisciplinary team to establish tentative discharge plan and contingency plans.
• Participate in planning for and the execution of patient discharge experience.
• Monitor patient experience: quality/timeliness/service appropriateness/payors/expectations.
• Facilitate team conferences weekly and coordinate all treatment plan modifications.
• Complete case management addendums and all required documentation.
• Maintain knowledge of regulations/standards, company policies/procedures, and department operations.
• Review/analyze case management reports, including Key Care Indicators, and plan appropriate actions.
• Understand commercial contract levels, exclusions, payor requirements, and recertification needs.
• Attend Acute Care Transfer (ACT) meetings to identify trends and collaboratively reduce ACTs.
• Meet with patient/family per Patient Arrival and Initial Visit Standard within 24 hrs of admission.
• Perform assessment of goals and complete case management addendum within 48 hours of admission.
• Educate patient/family on rehabilitation and Case Manager role; establish communication plan.
• Schedule and facilitate family conferences as needed.
• Assist patient with timely procuring/planning of resources to avoid discharge delays or issues.
• Monitor compliance with regulations for orthotics and prosthetics ordering and payment.
• Make appropriate/timely referrals, including documentation to post discharge providers/physicians.
• Ensure accuracy of discharge and payor-related information in the patient record.
• Participate in utilization review process: data collection, trend review, and resolution actions.
• Participate in case management on-call schedule as needed.

Qualifications

• License or Certification:
  • Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling).
  • If licensure is required for one's discipline within the state, individual must hold an active license.
  • Must meet eligibility requirements for CCM or ACM certification upon entry into this position OR within two years of entry into the position.
  • CCM or ACM certification required OR must be obtained within two years of being placed in the Case Manager II position.
• Minimum Qualifications:
  • For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN preferred. A diploma is acceptable only in those states whose minimum requirement for licensure or certification is a diploma rather than an Associate Degree.
  • For all other eligible licensed or certified health care professionals, must possess a minimum of a bachelor's degree and graduate degree is preferred.
  • 2 years of rehabilitation experience preferred.