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Registered Nurse Care Manager
2 months ago
Position Overview: The Care Coordinator RN serves as the primary link among patients, families, rehabilitation teams, and external agencies. This role involves providing essential information regarding patient progress, referrals, educational resources, and counseling for adjustment to both patients and their families while managing the discharge planning process. Adherence to professional standards, ethical codes, and organizational policies is paramount.
Key Responsibilities:
Case Management:
- Review all new patient admissions to ensure documentation meets compliance with insurance and pre-certification requirements.
- Document discharge-related issues at appropriate intervals to track progress.
- Communicate effectively with the healthcare team regarding patient status and insurance matters.
- Engage with insurance providers to secure necessary authorizations.
- Coordinate interdisciplinary team goals and facilitate family education to ensure seamless care transitions.
- Execute required documentation with patients and families as necessary.
- Provide ongoing care coordination and follow-up with patients, families, and healthcare professionals.
Financial Oversight:
- Monitor length of stay efficiency and facilitate discharge planning.
- Input financial and pre-certification information into the system to ensure timely processing.
- Collaborate with physicians and management to address any denied patient approvals.
- Communicate with insurance companies to ensure proper coverage and claims handling.
- Assist families in identifying and utilizing appropriate resources.
Communication:
- Liaise with physicians and administrative staff to facilitate benefits and pre-certification information for patients.
- Serve as a resource for the interdisciplinary team regarding insurance compliance.
- Keep all stakeholders informed about patient progress.
- Conduct meetings with patients, families, team members, and external case managers to review progress and prepare for timely discharges.
Compliance:
- Ensure authorization for necessary equipment as mandated by insurance.
- Maintain documentation that meets regulatory standards.
- Participate in chart audits as needed.
- Collaborate with the interdisciplinary team to ensure compliance with regulatory standards.
Qualifications:
Education:
- Associate's Degree in Nursing or graduation from an accredited CSWE Program is required; a Master's Degree in Social Work is also required.
Licenses and Certifications:
- Certification as a Case Manager or Licensed Clinical Social Worker in Georgia, or Licensed Master Social Worker in Georgia, or Registered Nurse (Single State) or RN - Multi-state Compact is required upon hire.
Experience:
- A minimum of 2 years of experience in medical case management within an inpatient rehabilitation setting is preferred.
Skills:
- Demonstrated experience in case management.
- Proficient computer skills.
- Strong verbal and written communication abilities.
- Excellent organizational and time management skills.
- Knowledge of the pre-certification process and medical terminology.
- Proven counseling skills and understanding of community resources and guidelines.
- Awareness of adult and geriatric developmental needs and the effects of illness and disability on patients and families.
