RN Case Manager

1 month ago

Huntsville, Alabama, United States Huntsville Memorial Hospital Full time
Job Summary

We are seeking a skilled RN Case Manager to join our team at Huntsville Memorial Hospital. This is a unique opportunity to work in a dynamic environment where you will be responsible for coordinating patient care and ensuring seamless transitions throughout the continuum of care.

Key Responsibilities
  • Facilitate pre-certification and payor authorization processes to ensure timely and efficient care delivery and reimbursement.
  • Collaborate with physicians and interdisciplinary teams to manage patient care and remove barriers to timely and efficient care delivery and reimbursement.
  • Employ process improvement methodologies to evaluate outcomes of care and identify areas for improvement.
  • Support and coach clinical documentation efforts and serve as a clinical resource for coders to ensure accurate documentation of patient care.
  • Coordinate communication with physicians and other healthcare team members to ensure effective care delivery.
  • Complete Utilization Management and Quality Screening for assigned patients to ensure appropriateness of admissions and continued stays.
  • Identify at-risk populations and follow established reporting procedures to ensure timely intervention.
  • Monitor Length of Stay (LOS) and ancillary resource use to achieve continuous improvement in both areas.
  • Refer cases and issues to the Care Management Medical Director (CMMD) in compliance with Department procedures and follow up as indicated.
  • Communicate with business office and payors to facilitate covered day reimbursement certification for assigned patients.
  • Discuss payor criteria and issues on a case-by-case basis with clinical staff and follow up to resolve problems with payors as needed.
  • Ensure that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
  • Manage all aspects of discharge planning for assigned patients to ensure smooth transitions and effective care delivery.
  • Actively participate in clinical performance improvement activities to drive quality and safety initiatives.
  • Collect, analyze, and address variances from the plan of care/care path with physician and/or other members of the healthcare team to ensure effective care delivery.
  • Use concurrent variance data to drive practice changes and positively impact outcomes.
  • Document key clinical path variances and outcomes that relate to areas of direct responsibility (e.g., discharge planning).
Requirements
  • Graduate of a school of professional nursing.
  • Two years of clinical nursing experience preferred as well as two years of hospital case management experience.
  • Current licensure as a Registered Nurse in the state of Texas.
  • Certification with the Fellowship of American Academy of Case Managers (FAACM) preferred.
Physical Demands and Working Conditions

Frequent sitting, standing, walking, and reaching. Occasional lifting, carrying, bending, and squatting. Visual and hearing acuity required. Work is inside, with good ventilation and comfortable temperature. Possible exposure to toxic/caustic chemicals or detergents, communicable diseases, and blood-borne pathogens.

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