Case Manager RN
6 days ago
Baylor Scott & White Medical Center - Sunnyvale is seeking a skilled Case Manager RN to join our team. As a Case Manager RN, you will play a vital role in assessing, planning, implementing, and evaluating the needs of patients for discharge planning and utilization review.
Key Responsibilities- Perform assessments on patients to determine discharge planning needs and document all assessments.
- Assess all aspects of patient care to optimize patient safety and reduce the likelihood of medical/healthcare errors.
- Communicate with physicians regarding discharge planning needs and assist in facilitating post-hospital care.
- Maintain knowledge of criteria for Medicare, Medicaid, Commercial, and private insurance coverage.
- Stay up-to-date on resources available within the community and maintain a supply of resource materials for patients.
- Communicate daily with admissions personnel regarding admissions and discharges to various units.
- Initiate ongoing communication with patients and their families to assess discharge needs.
- Treat patients and families with respect and dignity.
- Communicate with family members and caregivers regarding patient needs and anticipated plans.
- Interact professionally with patients/families and involve them in the formation of the plan of care.
- Document discharge planning in an ongoing manner.
- Maintain knowledge of patient financial status, diagnosis, and discharge needs.
- Ensure home care needs are met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when the date of discharge is known.
- Act on performance improvement issues identified during CQI meetings.
- Collaborate with Case Managers and insurance companies based on received information.
- Maintain confidentiality of patient/physician/personnel information.
- Collaborate with the Business Office Manager and onsite eligibility worker as needed.
- Accurately determine the type of assistance/setting/resources necessary for patients/families and provide appropriate resources/assistance.
- Participate in Utilization Management Committee, CQI, and other meetings as appropriate.
- Demonstrate flexibility, organization, and the ability to function under stressful situations.
- Maintain a good working relationship within the department and with other departments.
- Consult other departments as needed to collaborate on patient care and performance improvement activities.
- Ensure documentation meets current standards and policies.
- Current Registered Nurse licensure in the State of Texas.
- Motivated, independent individual who can organize workload to complete all functions appropriately.
- Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance coverage.
- Experience in providing patient care.
- Ability to read and communicate effectively in English.
- Additional languages preferred.
- Basic computer knowledge.
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