The Case Manager collaborates with patients, families, physicians, nursing staff, payors, and community providers to coordinate care across the continuum. The role integrates discharge planning, care coordination, utilization review, resource management, regulatory compliance, and patient advocacy to ensure safe transitions of care, optimal outcomes, and appropriate utilization of healthcare resources.
We're looking for a Full-Time Case Manager RN to join our Case Management team!
Care Coordination and Discharge Planning
- Conducts comprehensive assessments of patient needs and discharge barriers.
- Develops and updates individualized plans of care with the interdisciplinary team.
- Initiates discharge planning at admission and coordinates post-acute services.
- Ensures patient choice requirements are met in accordance with CMS regulations.
- Coordinates transitions between levels of care and community resources.
Utilization Review and Resource Management
- Performs initial and concurrent utilization review using approved criteria.
- Reviews admissions, observation stays, continued stays, and discharge readiness.
- Collaborates with providers regarding medical necessity and level-of-care determinations.
- Participates in denial prevention, denial management, and appeal activities.
- Monitors observation status, IMM and MOON compliance, and payer requirements.
- Identifies opportunities to reduce avoidable delays and excess length of stay.
Clinical Documentation and Regulatory Compliance
- Supports accurate clinical documentation.
- Maintains compliance with CMS Conditions of Participation, EMTALA, HIPAA, state and federal regulations, and Joint Commission standards.
- Completes required discharge planning and utilization review documentation.
Quality Improvement and Patient Advocacy
- Participates in performance improvement initiatives.
- Monitors outcomes, readmissions, length of stay, and transition-of-care metrics.
- Advocates for patients and families and supports informed decision-making.
Previous Case Management experience strongly preferred!
Great schedule: Work 32 hours per week. With rotating weekend shifts.
QUALIFICATIONS:
- Graduate of an accredited nursing or social work program.
- Current Colorado license or ability to obtain.
- BSN or LCSW preferred.
- Minimum two years acute hospital experience preferred.
- Case Management and Utilization Review experience preferred.
- Knowledge of MCG, or other medical necessity criteria preferred.
- Epic or electronic health record experience preferred.
Working Conditions:
- Subject to many interruptions and irregular hours
- Occasional pressure due to multiple interruptions and inquiries.
BENEFITS
- Medical, Dental and Vision coverage including coverage for eligible dependents
- Employer paid basic life coverage with buy-up coverage options
- Flexible Spending Account (FSA) for health care and dependent care.
- Time away from work: paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), Paid Sick/Bereavement Leave under Colorado Healthy Families and Workplaces Act (HFWA), leaves of absence.
- Tuition Assistance Available
- Retirement Plan 401(a)
- Retirement Plan 403(b) plans with employer matching contributions.
- Employee Assistance Program
- Employee discount on Valley View Medical Services
- Employee voluntary benefits such as Discounted RFTA bus passes, discounted gym memberships, Corporate Ski passes, free car seat for new Valley View babies born or adopted by Valley View employee(s)
- Free Use of Sunlight and Aspen SkiCo day passes, based on availability.
Loan Repayment:
Valley View is a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program!
APPLICATION SUBMISSION END DATE
This position will be open for a minimum of three days and until a top applicant is identified.
About Us
Located between Aspen and Vail, along the Colorado River, Glenwood Springs is a mecca for outdoor adventures in our beautiful mountains. When you are looking to relax, we also have the largest hot springs pool in the world. As a community with a population of about 10,000, Glenwood Springs is an ideal size.
At Valley View, our mission is to provide convenient, connected care to the communities of Western Colorado with scope, technology, and expertise that are rarely found in regional hospitals.
