Experienced Case Manager RN - Case Management (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.
• 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.
• Accesses and utilizes community resources, and is knowledgeable of relevant legislation and standards.
• Recognizes patients' individual needs based on medical conditions, age, limitations, and planned procedures.
• Communicates effectively both orally and in writing, and maintains professional affiliations.
• Adheres to departmental and hospital policies and procedures, and follows safety, quality assurance, and infection control standards.
• Promotes the quality and efficiency of performance through ongoing education and professional engagement.

Qualifications

• Graduate from an accredited school of nursing, RN.
• Minimum of two years' clinical experience required.
• Case management or Utilization management experience preferred.
• Current Mississippi RN license required.