RN Case Manager

4 weeks ago


Huntsville, Alabama, United States Huntsville Memorial Hospital Full time

h3JobDescription/h3pAtHuntsvilleMemorialHospital,weareseekingaskilledRNCaseManagertojoinourEmergencyDepartmentteam.Thisroleisresponsibleforprovidingsupporttophysiciansandtheinterdisciplinaryteaminfacilitatingpatientcare,withthegoalofenhancingclinicaloutcomesandpatientsatisfactionwhilemanagingcostsandprovidingtimelyinformationtopayors./ppTheRNCaseManagerwillintegrateandcoordinateutilizationmanagement,carefacilitation,anddischargeplanningfunctions,ensuringefficientutilizationofresourcesandeffectivemanagementofpatientneeds.Keyresponsibilitiesinclude:/pulliFacilitatingpre-certificationandpayorauthorizationprocesses./liliCollaboratingwiththehealthcareteamtomanagepatientcareacrossthecontinuum,interveningasnecessarytoremovebarrierstotimelyandefficientcaredeliveryandreimbursement./liliEmployingprocessimprovementmethodologiestoevaluateoutcomesofcare./liliSupportingandcoachingclinicaldocumentationeffortsandservingasaclinicalresourceforcoderstoensureaccuratedocumentationofpatientcare./liliCoordinatingcommunicationwithphysiciansandfacilitatingpatientcareprogressionthroughoutthecontinuumofcare./liliCompletingutilizationmanagementandqualityscreeningforassignedpatients./liliApplyingapprovedclinicalappropriatenesscriteriatomonitortheappropriatenessofadmissionsandcontinuedstays,documentingfindingsaccordingtodepartmentstandards./liliIdentifyingat-riskpopulationsandfollowingestablishedreportingprocedures./liliMonitoringlengthofstayandancillaryresourceuse,takingactiontoachievecontinuousimprovementinbothareas./liliReferencingcasesandissuestotheCareManagementMedicalDirector(CMMD)incompliancewithdepartmentproceduresandfollowingupasindicated./liliCommunicatingwiththebusinessofficeandpayorstofacilitatecovereddayreimbursementcertificationforassignedpatients,discussingpayorcriteriaandissuesonacase-by-casebasiswithclinicalstaffandfollowinguptoresolveproblemswithpayorsasneeded./liliEnsuringthatallcriticalelementsoftheplanofcarehavebeencommunicatedtothepatient/familyandmembersofthehealthcareteam,documentingasnecessarytoassurecontinuityofcare./liliManagingallaspectsofdischargeplanningforassignedpatients./liliActivelyparticipatinginclinicalperformanceimprovementactivities./liliAssistinginthecollectionandreportingoffinancialindicators,includingcasemix,lengthofstay,costpercase,avoidabledays,resourceutilization,readmissionrates,denials,andappeals./liliUsingdatatodrivedecisionsandplan/implementperformanceimprovementstrategiesrelatedtocasemanagementforassignedpatients,includingfiscal,clinical,andpatientsatisfactiondata./liliCollecting,analyzing,andaddressingvariancesfromtheplanofcare/carepathwiththephysicianand/orothermembersofthehealthcareteam,usingconcurrentvariancedatatodrivepracticechangesandpositivelyimpactoutcomes./liliDocumentingkeyclinicalpathvariancesandoutcomesthatrelatetoareasofdirectresponsibility,suchasdischargeplanning./liliEnsuringsafecaretopatients,adheringtopolicies,procedures,andstandards,withinbudgetaryspecifications,includingtimemanagement,supplymanagement,productivity,andaccuracyofpractice./liliAbidingbytheHuntsvilleMemorialHospitalLegalComplianceCodeofConduct./liliMaintainingpatientconfidentialityandappropriatehandlingofprotectedhealthinformation./liliMaintainingasafeworkenvironmentandreportingsafetyconcernsappropriately./liliPerformingallotherrelateddutiesasassigned./li/ulpRequirements/ppEducation:Graduateofaschoolofprofessionalnursing./ppExperience:RNwithtwoyearsofCaseManagementexperience,twoyearsofacutecarenursingexperience.TwoyearsofER/ICUexperienceaplus,experiencewithMillimanCareGuidelinesaplus./ppLicensure/Certification:CurrentlicensureasaRegisteredNurseinthestateofTexas.CertificationwiththeFellowshipofAmericanAcademyofCaseManagers(FAACM)preferred./ppRequiredSkills:Musthavestronganalytical,datamanagement,organizational,andtimemanagementskills.Performsdutiesinamannertopromotequalitypatientcareandcustomerservice/satisfaction,whilepromotingsafety,costefficiency,andacommitmenttotheCQIprocess./ppWorkSchedule:Monday-Friday10am-7pm(willrequireaSaturdayinCaseManagementrotation)/ppBenefits/pulliHealthCarePlan(Medical,Dental&Vision)/liliRetirementPlan(401k,IRA)/liliLifeInsurance(Basic,Voluntary&AD&D)/liliPaidTimeOff/liliShortTerm&LongTermDisability/liliTraining&Development/liliWellnessResources/li/ul


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