Case Manager Nurse

1 week ago


Morgantown, United States West Virginia University Health System Full time

To apply to this position and be considered, click the Apply button located above this message and complete the application in full. This position comprehensively plans for targeted patient populations. Performs resource management, including denial management, utilization management, access to the appropriate level of care, discharge planning, care facilitation, and referral to other levels of care. Works collaboratively with the multidisciplinary care team to facilitate achievement of desired treatment outcomes.

Current West Virginia licensure as a Registered Professional Nurse or licensure as Registered Professional Nurse in another state with a temporary West Virginia practice permit.

Bachelor's degree in Nursing (BSN)

Manages all aspects of transition/discharge planning for assigned patients in a timely manner.

intervening as necessary and appropriate, to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.

Provides education as needed to staff, physicians, and patients and their families to ensure effective transition planning.

Communicates with the multidisciplinary team and post-acute providers when applicable, any complex family dynamics that may directly impact patient care and transition/discharge planning.

Initiates and facilitates referrals to post-acute services- including but not limited to: Homecare, Durable Medical Equipment, Hospice Care, Long Term Acute Care Facilities, Acute Rehab Facilities, and Skilled Nursing Facilities.

Provides timely and comprehensive documentation of interactions with patient and/or families and all transition/discharge planning activities and progress according to departmental policy.

Assists patient/families with completion of medical power of attorney, health care surrogate, and advanced directives

Collaborates for appropriate resource and financial management which may include but is not limited to: financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination

Utilizes quality screens in the electronic record to identify potential issues including but not limited to- avoidable delays and readmissions.

Applies approved utilization criteria to ensure medical necessity of patient's admissions and continued stays, and documents the findings based on department standards, policy and procedure.

Screens for appropriate authorization and level of care.

Facilitates covered day reimbursement certification for assigned patients and discusses payor criteria and issues on a case by case basis with clinical staff (ie. Educates hospital staff and physicians to payer regulations and managed care principals to prevent denials.

Fosters the integration of staff and/or students into the healthcare team.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Working around infectious diseases.

Working with hands in water.

Working with electrical hazards associated with patient care equipment.

Knowledge of patient's current medical insurance coverage and limitations and the precertification requirements for Durable Medical Equipment (DME), post-acute placements, infusions, transfers etc

Knowledge of relevant scientific principles, established standards of care and/or research findings.

Knowledge of and appropriate application of the nursing process.

Shift:

WVUH West Virginia University Hospitals

403 WVUH Care Management

1 Medical Center Drive


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