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Inpatient Nurse Case Manager
2 months ago
Company: MedPOINT Management
Position: Inpatient Nurse - Managed Care Coordination
MedPOINT Management, a prominent Medical Services Organization, provides competitive compensation and benefits within a supportive work environment.
Key Responsibilities:
- Oversee patient transfers to designated hospitals when admission to an out-of-network facility is necessary, ensuring adherence to established protocols.
- Facilitate Emergency Room admissions by assessing patient stability and coordinating necessary authorizations.
- Document reasons for non-repatriation of patients to network facilities, ensuring accurate record-keeping.
- Verify the correct assignment of attending physicians and facilitate necessary changes to ensure optimal patient care.
- Coordinate patient transfers to specialized facilities for advanced medical care.
- Engage with hospital Utilization Review Departments to manage initial and ongoing reviews for patients.
- Maintain accurate clinical documentation within the EZ-cap system.
- Assign appropriate Levels of Care and authorize services based on established medical necessity guidelines.
- Identify and report unnecessary hospital days to the Medical Director for review.
- Manage discharge planning processes, ensuring smooth transitions to home care or other facilities.
- Authorize necessary post-discharge services, including home health care and medical supplies.
- Conduct weekly reviews of skilled nursing facility patients to ensure ongoing quality of care.
- Facilitate disenrollment processes for patients transitioning to long-term care beyond 30 days.
- Authorize inter-facility ambulance transfers as needed.
- Participate in daily inpatient meetings to review bed day reports and maintain accurate logs.
- Refer potential readmissions to appropriate case management services for follow-up.
- Report any quality of care concerns to the Quality Improvement Department for further evaluation.
