Per Diem Case Manager
7 days ago
We are seeking a skilled Per Diem RN Case Manager to join our team at North Mississippi Health Services. As a key member of our healthcare team, you will be responsible for coordinating patient care and ensuring seamless transitions between levels of care.
Key Responsibilities- Monitor individual cases to ensure compliance with established criteria, LOS, and patient care guidelines.
- Assure patients meet level of care criteria and issue denial of care letters as necessary.
- Intervene as indicated to promote timely provision of care and utilization of resources.
- Serve as a resource for physicians and nurses in understanding criteria for continued stay and medical necessity.
- Monitor patient outcomes to evaluate clinical and financial effectiveness.
- Reconcile services rendered with patient benefits and communicate with physicians and 3rd party payers to ensure appropriate reimbursement.
- Collaborate with patient care team to move population along the continuum by effectively planning for continued care as moving to another level of care to ensure all patient needs are addressed.
- Assess social/emotional factors affecting health status of patients and make appropriate referrals.
- Participate on Discharge Planning Team and initiate d/c planning early in the treatment process based on requirements of the plan of care and needs identified during initial assessment.
- Participate on SWB Team and facilitate screening of patients for eligibility.
- Provide SWB information to patients and families as appropriate.
- Monitor patient progress for timely discharge to the appropriate setting.
- Assist with MDS as required for billing/reimbursement as needed.
- Identify and report physicians' practice patterns and resource utilization.
- Maintain accurate records of review and discharge planning activities.
- Trend and report lack of medical necessity for admissions, observation vs admission appropriateness, and LOS.
- Maintain constructive working relationships and communication with physicians, professional staff, and other members of the healthcare team regarding issues of continued stay and documentation of medical necessity.
- Collaborate with business office to ensure accurate billing and statistical information.
- Collaborate with social worker to identify and coordinate resources, internal and external, to best meet patient needs.
- Competent to communicate on all levels to assess discharge needs of all age groups of patients.
Requirements:
- Currently licensed in Alabama as a Registered Nurse and in good standing with the State Board of Nursing.
- Minimum of 5 years of experience with a broad base of clinical expertise.
- Ability to read and interpret medical record documentation.
- Ability to operate a PC.
- Good organizational skills and high level of self-initiative.
- Effective verbal and written communication skills.
- Maintains current ACLS and BLS certifications.
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