PRN RN Case Manager- Saturday/Sunday

Essential Job Functions

• Facilitates pre-certification and payor authorization processes
• Facilitates collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
• Employs process improvement methodologies in evaluating outcomes of care
• Serves as a clinical resource for coders ensuring that documentation accurately reflects severity of illness and intensity of service
• Captures and analyzes variances from the plan of care/care path with physician and/or other members of the healthcare team
• Manages all aspects of discharge planning for assigned patients
• Affirms safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice
• Maintains patient confidentiality and appropriate handling of PHI
• Maintains a safe work environment and reports safety concerns appropriately

Specific Functions

• Supports and coaches clinical documentation efforts
• Coordinates communication with physicians
• Coordinates and facilitates patient care progression throughout the continuum of care
• Completes Utilization Management and Quality Screening for assigned patients
• Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, then documents findings based on Department standards
• Identifies at-risk populations and follows established reporting procedures
• Makes referrals and issues to Care Management Medical Director (CMMD) in compliance with Department procedures and follows up as indicated
• Communicates with business office and payors to facilitate covered day reimbursement certification for assigned patients
• Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care
• Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data
• Documents key clinical path variances and outcomes that relate to areas of direct responsibility (e.g., discharge planning)

Requirements

• Education: Graduate of a school of professional nursing
• Experience: Two years of clinical nursing experience preferred as well as two years of hospital case management experience
• Licensure/Certification: Current licensure as a Registered Nurse in the state of Texas. Certification with the Fellowship of American Academy of Case Managers (FAACM) preferred
• Required Skills: Strong analytical, data management, organizational and time management skills