CASE MANAGER-Registered Nurse PRN

Responsibilities

• Applies to individual case, through chart review, third payer regulations that govern admissions, continued stay, and discharge, i.e. IS/SI.
• Collects data related to clinical improvement initiatives for the purpose of developing action plans.
• Conducts concurrent chart reviews to assure complete and accurate medical records documentation.
• Collaborates with the health care team including the patient, caregiver, and or family members and case management to coordinate the patient's plan of care.
• Demonstrates proficiency in patient assessment and documentation.
• Interviews and assesses patients to determine potential barriers to timely discharge/transfer to another level of care.
• Provides all payers with accurate, updated information.
• Obtains covered stay certification and prior authorization as appropriate.
• Refers cases when appropriate to physician advisor for medical necessity, continued stay, physician education and appropriate level of care.
• Refers to Social Services when appropriate.
• Ensures discharge planning to the appropriate level of care, sub-acute, hospital units, and outpatient services.
• Supports hospital CQI programs by participation on relevant teams.
• Performs other duties as needed and/or assigned.

Qualifications

• Knowledge of appropriate and timely return transition levels of care.
• Knowledge of CARF, Regulatory Agencies and State Board of Health, Long Term Care, Acute Care and Ambulatory Care Standards.
• Demonstrates excellent interpersonal and problem-solving skills.
• Demonstrates self-directed, goal orientated and customer service.
• Excellent organizational and prioritization skills to meet deadlines.
• Capable of functioning effectively across service lines.
• Ability to assess and interpret data about the patients status in order to identify each patients age, specific needs and provide the care needed by the infant, child, adolescent, young adult, middle adult and geriatric patient.
• Ability to independently perform comprehensive chart review with subsequent abstraction or relevant information including interpretation of lab results, EKG and other medical tests.
• Ability to communicate effectively both verbally and in writing.
• Ability to provide compassionate patient care orientated with an effort for timeliness and accuracy in the delivery of service.
• Ability to respond positively to the needs of patients and family. Addresses customer concerns in a private, respectful and calm manner.

Education

• All post high school education must have been obtained from a recognized College or University.
• Nursing Degree Required.
• Bachelor’s Nursing Preferred.

Experience

• 3 years Acute Care experience Required.