Experienced Case Manager - RN PRN Premium

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.
• Partners with unit personnel to resolve utilization/case management problems and communicate identified issues to appropriate personnel.
• Assesses patient clinical information and collaborates with the healthcare team to develop treatment and discharge plans.
• Evaluates the quality of necessary medical services and interacts with physicians to facilitate patient assignment to appropriate alternative care.
• Provides information to third-party payors to ensure appropriate financial outcomes and that patients are receiving the correct level of care.
• Tracks and reports avoidable days and demonstrates competence in coordination and service delivery.
• Accesses and utilizes community resources and is knowledgeable of relevant legislation and regulations.
• Adheres to departmental and hospital policies and follows safety, quality assurance, and infection control standards.
• Promotes the quality and efficiency of performance through ongoing education and professional engagement.

Qualifications

• Three years of general or specialty nursing practice experience.
• A degree from an accredited college or university, preferably in nursing, with an emphasis on case management or geriatrics.
• A current and unrestricted Mississippi State License as Registered Nurse (RN).