Case Manager RN
5 days ago
Job Summary:
As a skilled Case Manager RN, you will play a vital role in ensuring the seamless delivery of medical services and effective discharge planning for a specified patient population. Your expertise will be instrumental in promoting a cooperative and supportive relationship with patients, families, facility staff, physicians, funding representatives, and community agencies.
Key Responsibilities:
- Communicate proactively and cooperatively with Patient Access, Patient Account Services (PAS), and Central Verification Office (CVO) personnel to ensure proper pre-certification and consistency of admissions status designation between physician order and EMR.
- Communicate known changes to patient payer information and other relevant financial characteristics of coverage to appropriate admissions and billing personnel.
- Proactively ensure that required clinical justification is provided to third-party payers to obtain recertification for continued hospitalization and treatment and that transfer of this information, together with days approved and contact information is provided timely to the PAS and CVO via computerized insurance review documentation.
- Serve as a liaison between third-party payers, patient access PAS, and CVO to ensure communication of all pertinent information regarding level of care, billing, and reimbursement.
- Work with the patient and family to identify alternate financial resources available to meet the cost of necessary post-discharge needs or to recommend alternate care options when necessary funding is unavailable.
- Proactively initiate an expedited appeals process with payers and communicate with denials management regarding anticipated or verified denials and cooperate with denials management to provide additional clinical information for appeals.
- Educate patient and family on case manager role and process for contacting the case manager for questions.
Requirements:
- RN licensure in the state of TX or Compact State.
- Associates Degree or BSN completion within 3 years of hire date.
- Must have Case Management experience within the acute care setting min 2 years.
Why Great Bay Staffing Group:
Great benefits. Relo offered
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