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Case Manager RN
5 months ago
- Five years recent relevant clinical experience in anacute care facility required.
- StrongInterpersonal skills and ability to work with patients, families,providers, peers, and other departments required.
- Ability to use word processing and computer spreadsheetsand other computer-based programs required to do the job. Excellentcommunication and problem-solving, and critical thinkingskills.
- Strong patient educationabilities.
- Knowledge of and experience withInterQual® Level of Care Criteria, experience in automatedInterQual® preferred.
- Knowledge of theregulatory environment, including Medicare Conditions ofParticipation, DNV standards, HIPAA, and reportingrequirements.
- Submits appeals in a timelymanner, upon request by the Director.
- Initiates discharge planning on assigned patients within24 hours of admission. Revises discharge planning as indicated bychanges in the patient’s condition and circumstances.
- Arranges for the post-discharge needs ofpatients.
- Clearly and accurately documents allpatient/family interventions and interactions.
- Monitors for the efficient use of resources and reportsto Director when there are actual or potential sources of under- orover-utilization.
- Collaborates with providers,nurses, patients, families, and other care providers in thedevelopment and implementation of patient care plans, includingdischarge planning, across the continuum of care in support of theGCRMC Mission.
- Communicates with providersregarding patient status and assists him/her in ensuring properplacement of patient.
- Conducts utilizationreview using nationally recognized medical necessity criteria anddocuments the review.
- Refers cases for secondlevel reviews when medical necessity criteria are notmet.
- Demonstrates familiarity with the variouslevels of care and community resources available for each patientand the providers of these different aspects of care.
- Actively participates in interdisciplinary treatmentplanning rounds.
- Utilizes innovative methodsto facilitate development and implementation of dischargeplans.
- Makes self available as resource tonursing staff. Provides learning experiences to strengthen andexpand the staff’s expertise.
- Participates ininfection control activities by screening, monitoring, andreporting individual cases and/or trends to the infection controlnurse.
- Performs utilization managementfunctions as required by payer source.
- Complies with the Utilization Management Plan.
Requirements
Education
Required:
Associateof Science
Licenses &Certifications
Required:
L-RNSinglestate
Preferred:
L-RNMultistate
C-BLS
