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Case Manager RN
3 months ago
Case Management
Schedule/Status:
8am-430pm; Full Time
Standard Hours/Week:
40
GENERAL DESCRIPTION
Under the general supervision of the Director, Case Management is responsible for the management and coordination of total plan of patient care from the point of admission to the point of discharge. Patient case management includes utilization review for appropriateness and efficiency, initial assessment and planning for discharge needs.
The position shall exemplify the desired Culture of Choice and philosophies of Parrish Healthcare.
KEY RESPONSIBILITIES
- Assesses and evaluates the patients plan of care within 24 hours of admission and at least every 96 hours utilizing Milliman criteria determining appropriate patient status that coincides with 2MN rule and medical necessity of hospital admission.
- Documents and conveys appropriate information regarding patients admission and continued hospitalization to various payors for authorization and reimbursement purposes.
- Collaborates and makes referral to physician advisor when unable to resolve issue with attending physician.
- Meets with patient and/or family/personal representative as soon as possible, but not greater than 48 hours of admission, to assess, evaluate, and identify discharge needs. Provides support and information, as needed
- Collaborates with physician and other members of the health care team to develop, plan, and facilitate a safe and realistic discharge plan, adjusting as needed throughout patients hospitalization.
- Coordinates, plans, documents, and participates in interdisciplinary discharge planning meetings, identifying barriers to discharge with participation of all disciplines.
- Assures completion of discharge forms, i.e. Important Message from Medicare, PASRR, transportation, within established timeframes and according to state/federal regulations.
- Proactively monitors patient activity, identifying and resolving delay and barriers to discharge. Monitors length of stay, readmissions, and documents avoidable days for trending and performance improvement purposes.
- Assesses and evaluates the medical necessity and appropriateness of ancillary testing, medications, treatment, and plan of care, discussing concerns with the involved physician, nurse or ancillary staff member. Make appropriate referral to physician advisor regarding trends/areas of concern. Task CM assistant with activities to coordinate the discharge plan. Identify patients with complex discharge planning needs and complex psychosocial needs make appropriate referral to Social Work case manager. Monitor patients who are within BPCI program and coordinate post hospital services.
- Demonstrates the knowledge and skills necessary to provide appropriate care in consideration of the growth development, and social needs of pediatric, adolescent, adult, and geriatric patients. Enhances professional growth and development through participation in educationalprograms, current literature, in-services, meetings, and workshops.
Formal Education:
- Bachelors or Associates Degree required. Major(s) required: Nursing
- 2 years to
