Experienced Case Manager - RN

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.
• Evaluates the quality of necessary medical services and interacts with physicians to facilitate patient assignment to appropriate alternative care.
• Provides appropriate and timely information to third-party payors to ensure financial outcomes and appropriate level of care.
• Demonstrates competence in coordination and service delivery, assessing patient clinical information and developing treatment/discharge plans in collaboration with the healthcare team.
• Recognizes patients' individual needs based on medical conditions, age, limitations, and planned procedures.
• Communicates effectively with unit personnel to resolve utilization/case management problems and enhances departmental operating efficiency.
• Tracks and reports avoidable days and plays a key role in the discharge planning process, assessing patient needs for referrals and alternate levels of care.
• Accesses and utilizes community resources, understands ADA and other federal legislation affecting individuals with disabilities, and establishes a client support system.
• Remains current with the latest trends in the field of expertise through participation in job-relevant seminars and workshops, attendance at professional conferences, and affiliations with national and state professional organizations.

Qualifications

• Graduate from an accredited school of nursing, RN.
• Minimum of two years' clinical experience required.
• Case management or utilization management experience preferred.
• Ability to recognize patients' individual needs based on medical conditions, age, limitations, and planned procedures.
• Current Mississippi RN license required.