RN-PEDIATRIC REHAB CARE MANAGER

1 month ago

Columbia SC USA, United States Prisma Health Full time
Inspire health. Serve with compassion. Be the difference.

Job Summary

Performs activities and duties related to preadmission assessment screening and admission of patients to the Pediatric Inpatient Rehabilitation Unit. Serves as Case Management resource for patients and family members. Assesses patient progress with rehabilitation plan of care and partners with Pediatric Inpatient Rehabilitation leadership and therapy team members to promote the rehabilitation process for each patient. Provides expert guidance on regulatory and compliance concerns for Case Management. Performs discharge planning activities for patients, and proactively identifies and resolves obstacles of patient rehabilitation, monitoring the documentation of patient medical records.

Accountabilities

Conducts insurance and pre-admission screenings, as well as clinical assessments, to ensure that patients qualify for rehabilitation admission and insurance/payer reimbursement. Facilitates the smooth transition of patients into the Pediatric Inpatient Rehabilitation Unit by coordinating transportation and receiving times and dates. Educates patients, family members, referral sources, and external payers regarding the effective and efficient utilization of program services and available resources. 25%

Serves as Case Management resource for patients and families with regard to their rights and responsibilities, when payment of care is denied or when acute rehabilitative care is no longer necessary. This include, but is not limited to, delivery of regulatory documents as provided by CMS. On the basis of preliminary risk screening, assesses patients' and families' psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness, and ability to cope. 15%

Performs discharge planning activities for patients with complex medical issues, in order to ensure a timely discharge and to provide appropriate linkage with post-acute rehabilitation care providers. Addresses and resolves system problems impeding rehabilitation progress. Proactively identifies and resolves delays and obstacles during the rehabilitation discharge planning process. Monitors patient progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient and family-focused, high quality, efficient, and cost effective. 15%

Partners with Pediatric Inpatient Rehabilitation Center leadership and Prisma Health Marketing and Communications to promote the rehabilitation services by conducting phone calls and site visits to screen potential children and young adults for admission while also promoting awareness of services. Develops relationships with referral sources. 10%

Assists the Pediatric Inpatient Rehabilitation team in the development, maintenance, evaluation, and interpretation of clinical data pertaining to admissions and discharges on the Pediatric Inpatient Unit. 10%

Attends and facilitates weekly Inpatient Pediatric Rehabilitation Case Conferences and Family meetings, discussing individual patient progress with rehabilitation, and coordinates the documentation of meetings. 10%

Participates with Pediatric Inpatient Rehabilitation Center team in the completion and monitoring of compliance guidelines for the Commission on Accreditation of Rehabilitation Facilities and the Joint Commission. 5%

Provides expert guidance and assistance to Pediatric Inpatient Rehabilitation Center clinical staff on regulatory and compliance concerns for Case Management and Utilization Management. 5%

Monitors the medical record documentation of patients to ensure quality and accuracy. 5%

Supervisory/Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Education

Associate's degree - Graduate of an accredited school of Nursing and approved by the South Carolina State Board of Nursing.

Minimum Experience

3 years - Acute care nursing experience. One year of case management experience is preferred.

Required Certifications/Registrations/Licenses

RN Currently licensed in South Carolina

BLS required

SC valid driver's license

Other Required Experience

Demonstrated expertise in analysis, decision-making, time management, oral and written communication, and computer skills - required

Knowledge of regulations of agencies involved in program operation and resources available for use in assessing regulations and parameters of third-party reimbursement - preferred

Excellent assessment skills and ability to function independently - required

Knowledge of insurance and managed care principles and practices - preferred

Work Shift

Day (United States of America)

Location

7 Medical Park Rd Richland

Facility

1510 Richland Hospital

Department

15107517 Hospital Case Management

Share your talent with us Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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