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Austin, United States Central Health Full timeOverview Under general direction of the Associate Director of Case Management, identifies, screens, tracks, monitors and coordinates care to ensure highest quality care for client's disease state. Utilizes clinical skills to review and monitor utilization of health care services with the goal of maintaining high quality cost-effective care while engaging and...
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RN Case Manager
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RN Case Manager Hospice
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austin, United States Amedisys Inc Full timeRN Case Manager HospiceOverview Full Time Days Are you a highly skilled and compassionate registered nurse (RN) looking for a rewarding career in hospice as a case manager? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U.S. Attractive pay 75-83k Enjoy great perks and benefits A...
Case Manager RN
1 month ago
At Cornerstone It Starts With Me. Our commitment is to deliver excellence and an empathetic human experience to every patient, every family member, every employee, every time. We do this through our Core Values which help in guiding our work every day. Job Summary: The Case Manager II coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning. Essential Functions: Care Coordination * Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians. * Monitors all areas of patients' stay for effective care coordination and efficient care facilitation. * Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care. * Appropriately refers high risk patients who would benefit from additional support. * Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions. * Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served. * Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post hospital needs. Collaborates with clinical staff in the development and execution of the plan of care, and achievement of goals. * Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in the planning of the patients' care throughout the care continuum. Discharge Planning * Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning. * Provide comprehensive discharge planning for each patient. Utilizes critical thinking to develop and execute effective discharge planning. * Coordinates and communicates with patient/family efficiently and effectively. Utilization Management * Conducts medical necessity review for appropriate utilization of services from admission through discharge. * Promotes effective and efficient utilization of clinical resources. * Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor. Education: Graduate of an accredited program required: * RN, BSN preferred OR * Master of Social Work with licensure as required by state regulations; OR * Bachelor of Social Work with licensure as required by state regulations Licenses/Certification: * Healthcare professional licensure required as Registered Nurse or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations. * Certification in Case Management preferred. Experience: * Two years of experience in healthcare setting preferred. * Prefer prior experience in case management, utilization review, or discharge planning. Knowledge/Skills/Abilities/Expectations: * Knowledge of government and non-government payor practices, regulations, standards and reimbursement. * Knowledge of Medicare benefits and insurance processes and contracts. * Knowledge of accreditation standards and compliance requirements.
