Case Manager RN
2 days ago
As a key member of our team, the Case Manager RN will provide comprehensive coordination in the delivery of medical services and discharge planning for a specified patient population. This role involves performing concurrent and retrospective review of patient medical records for purposes of utilization review, compliance with requirements of external review agencies, and quality assurance agencies.
Key Responsibilities- Communication and Coordination
The Case Manager RN will communicate proactively and cooperatively with Patient Access, Patient Account Services (PAS), and Central Verification Office (CVO) personnel to ensure proper pre-certification and consistency of admissions status designation between physician order and EMR.
Payer Communication and ReimbursementThe Case Manager RN will serve as a liaison between third-party payers, patient access PAS, and CVO to ensure communication of all pertinent information regarding level of care, billing, and reimbursement.
Financial Resource Identification and Alternate Care OptionsThe Case Manager RN will work with the patient and family to identify alternate financial resources available to meet the cost of necessary post-discharge needs or to recommend alternate care options when necessary funding is unavailable.
Expedited Appeals Process and Denials ManagementThe Case Manager RN will proactively initiate an expedited appeals process with payers and communicate with denials management regarding anticipated or verified denials and cooperate with denials management to provide additional clinical information for appeals.
Patient and Family EducationThe Case Manager RN will educate patient and family on case manager role and process for contacting the case manager for questions.
About NPAworldwide
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