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Registered Nurse Case Management Specialist
2 months ago
At Kindred Hospital Houston Medical Center, we prioritize a compassionate approach to healthcare.
Our mission is to provide exceptional care and a supportive experience for every patient, their families, and our staff.
Position Overview:
The Case Manager RN plays a pivotal role in coordinating and facilitating patient care through effective collaboration with the Interdisciplinary Care Transitions (ICT) team.
This role involves following patients through their entire care journey, ensuring optimal resource utilization, service delivery, and adherence to external review standards.
The Case Manager RN provides ongoing support and expertise through thorough assessments, care planning, implementation, and evaluation of individual patient needs.Our goal is to enhance patient management quality and satisfaction, promoting continuity of care and cost-effectiveness by integrating case management, utilization review, and discharge planning functions.
Key Responsibilities:
Care Coordination
- Collaborates with the Interdisciplinary Team and Physicians to coordinate clinical and psycho-social activities.
- Monitors patient care throughout their stay to ensure effective coordination and facilitation.
- Stays informed about reimbursement practices, community resources, and psychosocial and legal matters affecting patients and care providers.
- Refers high-risk patients for additional support as needed.
- Acts as a patient advocate, fostering collaborative relationships to empower patients and families in decision-making.
- Demonstrates knowledge of growth and development principles to provide age-appropriate care.
- Participates in interdisciplinary rounds and conferences to review treatment objectives, optimize resource use, educate families, and identify post-hospital needs.
- Coordinates care planning with the interdisciplinary team, physicians, patients, families, post-acute providers, payors, and others throughout the care continuum.
- Conducts thorough and ongoing assessments to ensure timely and safe discharge planning.
- Develops and executes comprehensive discharge plans utilizing critical thinking.
- Effectively communicates with patients and families regarding discharge processes.
- Reviews medical necessity for appropriate service utilization from admission to discharge.
- Promotes efficient use of clinical resources.
- Conducts timely clinical reviews and coordinates continued stay authorizations with payors.
Qualifications:
Education:
- Graduate of an accredited nursing program required:
- RN, BSN preferred
- Master of Social Work with necessary state licensure;
- Bachelor of Social Work with necessary state licensure
Licenses/Certification:
- Required healthcare professional licensure as a Registered Nurse or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) as mandated by state regulations.
- Certification in Case Management is preferred.
Experience:
- Preferred two years of experience in a healthcare environment.
- Previous experience in case management, utilization review, or discharge planning is advantageous.
Knowledge/Skills/Abilities:
- Familiarity with government and non-government payor practices, regulations, and reimbursement standards.
- Understanding of Medicare benefits and insurance processes.
- Knowledge of accreditation standards and compliance requirements.
