CASE MANAGER- RN required

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.

Qualifications

• Bachelor’s Nursing Required
• Required RN Case Manager Experience
• Licensed Registered Nurse
• Certified Cardiac Pulmonary Resuscitation

Education

• Bachelor’s Nursing Required

Standards of Behavior

• Mets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.

Confidentiality/HIPAA/Corporate Compliance

• Demonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information.
• Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.