Care Manager
4 weeks ago
We are seeking a highly skilled and compassionate RN Case Manager to join our team at North Oaks Medical Center. As a RN Case Manager, you will play a vital role in ensuring the seamless transition of patients from one level of care to another, while promoting optimal health outcomes and resource utilization.
Key Responsibilities:- Contribute to the development of a goal-directed, age-appropriate plan of care through an interdisciplinary team process.
- Assess patients' biophysical, psychosocial, environmental, economic/financial, and discharge planning needs to assist in the development of patient-centered goals of care.
- Plan for barriers to effective transitions of care.
- Procure services and resources, serving as an advocate for patients and families.
- Communicate patient needs and follow up with appropriate professionals.
- Assess the appropriateness and timeliness of the level of care, diagnostic testing, clinical procedures, quality and clinical risk issues, and documentation completeness.
- Communicate continually with physicians, patients, caregivers, and care team members to facilitate coordination of clinical activities to enhance a seamless transition from one level of care to another.
- Seek information and resources for use in creative problem solving for complex discharge planning, quality of care, and utilization issues.
- Explore new resources when opportunities for the patient are absent or in short supply.
- Work collaboratively with other departments and services to define and study areas of inefficiency to participate in process improvement projects.
- Study available information to remain abreast of reimbursement modalities, community resources, review systems, and clinical and legal issues that affect patients and providers of care.
- Serve as a resource and provide education to physicians, patients, caregivers, and professional staff on levels of care, quality of care issues, and regulatory concerns.
- Provide orientation and mentoring to new staff members.
- Foster positive internal and external customer relations.
- Work in accordance with applicable state and federal guidelines and with the unique requirements of reimbursement systems.
- Knowledgeable about and acts in accordance with laws and procedures regarding patient confidentiality and release of information, Americans with Disabilities Act, other laws protecting rights, and worker's compensation laws when applicable to the care manager's practice.
- Perform other duties, projects, or subjects as assigned by departmental leadership.
- Follow Infection Control policies and procedures at all times per system guidelines.
- Follow North Oaks Health System's Compliance Programs and Federal and State regulatory guidelines.
- Coordinate transitions in care with payer source to minimize financial impact to patient/family and organization.
- Review physician orders to ensure appropriate level of care orders are in the medical record.
- Graduate of a RN program.
- Registered Nurse licensed to practice in the State of Louisiana.
- A Minimum three years of clinical nursing, case management and/or utilization review experience.
- Emergency services and/or utilization review/case management experience preferred.
- Knowledge of established medical necessity criteria and their application preferred.
- Knowledge of Medicare, Medicaid, Managed Care Organizations, Social Services, discharge planning, community resources, and referral agencies strongly preferred.
- Knowledge of ICD-10 coding, Case Mix Index monitoring, and legal compliance, and clinical documentation preferred.
- Knowledge of Peer Review and payer functions preferred.
- Knowledge of third party payor appeal process preferred.
- Knowledge of Quality Improvement activities/Team Leader/Facilitator training preferred.
- Sedentary.
- Occasional pushing, pulling, carrying, lifting, sitting, standing, and walking.
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