Case Manager RN, Our Lady of the Lake (Full Time Days)

Responsibilities

• Evaluates and analyzes patient charts and treatment plans to ensure adherence to quality care and treatment criteria.
• Collaborates with physicians, third-party payors, and federal/local agencies to prevent denials of payment or days.
• Works with the treatment team to discuss issues related to continued stay, discharge, and aftercare plans.
• Communicates identified problems to appropriate personnel to enhance departmental operating efficiency.
• Partners with all members of the health team to optimize reimbursement, discharge planning, and cost-effective quality care.
• Affordably assesses patient clinical information and collaborates with the healthcare team to develop treatment/discharge plans.
• Evaluates the quality of necessary medical services and interacts with physicians to facilitate patient assignment to appropriate alternative care.
• Coordinates denials/appeals and ensures patients are receiving appropriate level of care.
• Accesses and utilizes community resources and is knowledgeable of relevant legislation and ADA.
• Tracks and reports avoidable days and appropriately manages patient referrals and alternate levels of care.
• Remains current with industry trends through participation in seminars, workshops, and professional conferences.

Qualifications

• Three years of general or specialty nursing practice experience.
• Associate's Degree in Nursing (RN).
• Current and unrestricted Louisiana State License as Registered Nurse (RN).