Case Manager

3 weeks ago


Hattiesburg, Mississippi, United States Forrest General Hospital Full time
Job Summary

We are seeking a skilled Case Manager to join our team at Forrest General Hospital. The successful candidate will be responsible for planning, coordinating, and evaluating the care of assigned patients to achieve quality, cost-effective patient outcomes.

Key Responsibilities
  • Develop and implement discharge plans for patients, ensuring timely and effective transitions to post-acute care.
  • Collaborate with interdisciplinary teams to identify services required to meet patient and family needs, ensuring that appropriate resources are implemented in a timely manner.
  • Conduct daily care management team meetings to review patient progress and adjust care plans as needed.
  • Assign Working DRG length of stay on all new inpatient admissions, ensuring accurate and timely coding.
  • Provide assistance to ensure placement of patients in the most appropriate care setting, considering factors such as medical necessity and resource availability.
  • Collaborate with physician and registration staff to validate appropriateness of admission, services, and continued stay, and issue letters of non-coverage as necessary.
  • Evaluate the use of observation bed services to ensure timely discharge and avoid potential loss of reimbursement.
  • Apply interventions to proactively prevent readmissions, identifying causes of readmission to inform future care planning.
  • Perform timely level of care reviews concurrently on assigned patients, relative to the prospective payment system for Medicare, Medicaid, private payers, and other hospital utilization management applications.
  • Assist with admissions to ensure patients are placed in the correct level of care, and continue to monitor throughout the hospital stay.
  • Obtain authorization from third-party payers in a timely manner, and consistently follow-up and update authorization/certification information.
  • Track denials and appeals, documenting them on a consistent basis, and refer to the denial management coordinator as needed.
Requirements
  • Three or more years of experience in clinical nursing, with case management and/or utilization management experience preferred.
  • Degree from an accredited, non-online RN program, preferred. Associate or Bachelor of Science in Nursing required.
  • Licensed RN able to practice within the State of MS, with certification/Licensure required upon hire.
Performance Expectations
  • Achieve productivity goals, responding positively to multiple tasks and demonstrating the ability to manage daily workload.
  • Adhere to various regulatory guidelines, demonstrating the ability to learn and follow new guidelines.
  • Demonstrate practices of established patient safety and infection control interventions.
Working Conditions

The Case Manager will work in a fast-paced hospital environment, requiring exceptional oral and written skills to relate effectively to hospital staff, physicians, and review agencies. The individual must have the ability to type, use a copier, telephone, and personal computer, and workable knowledge of DNV standards and other regulatory systems is essential.


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