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RN Care Manager
2 months ago
The Care Manager plays a vital role in ensuring the seamless coordination of patient care. This individual will effectively communicate with internal and external clinical professionals to organize patient care, assess homes for needs, and make appropriate arrangements. The ideal candidate will possess strong critical thinking skills, multitasking abilities, and excellent communication skills.
Key Responsibilities- Maintain consistency with Administrative and Departmental policies, demonstrating appropriate behavior, dress, attitude, attendance, confidentiality, professionalism, and reliability.
- Identify, evaluate, and provide case management services for patients, analyzing information supplied by physicians to make timely review determinations based on appropriate criteria and standards.
- Coordinate certifications of services with the appropriate payor, ensuring timely and accurate documentation.
- Identify and refer over/under utilization issues and refer appropriate cases to VP Medical Affairs.
- Initiate timely and appropriate Discharge Planning, ensuring a smooth transition for patients.
- Collect and analyze data to assure quality outcomes, serving as a liaison for patient, family, and physician to assist in communication.
- Reinforce and interact with patients, physicians, and families across the continuum to include post-acute services, ensuring timely medical record documentation.
- Experience: Minimum of five years recent clinical experience as an RN, with negotiating skills to interact with physicians, nursing staff, discharge planners, and payers.
- Excellent verbal and written communication skills, with knowledge of clinical protocol, normative data, and health benefit plans.
- Ability to manage several projects and cases simultaneously, with knowledge of community resources.
- Education: Bachelor's Degree in Nursing, preferred.
- Licenses, Registrations, or Certifications: Current Registered Nurse License.
Full Time
