RN Case Manager - Full Time, Days (Hollywood)

About the role

The RN Case Manager is responsible for performing clinical assessment and reassessment of acute care inpatients for the purpose of performing utilization review, resource management and safe discharge planning. The RN Case Manager prioritizes, plans, organizes, and implements timeliness of care. Collaborates with the interdisciplinary healthcare team to promote and coordinate the delivery of safe and cost-effective patient care, transition of care and discharge planning. The RN Case Manager advocates for patient self-determination and choice. Practices clinical competence in evaluations and planning with awareness and respect for patient and family diversity. Monitors and coordinates resource utilization throughout the continuum of care and evaluates timeliness of services. Performs admission, continued stay and discharge review utilizing medical staff-approved decision support criteria.

Responsibilities

• Collaborates as needed with the patient and family to optimize client outcomes. May include work with community, local and state resources, primary care provider, and members of the health care team, payer, and other relevant health care stakeholders to facilitate appropriate patient transfers, discharges and transitions of care.
• Identifies timely and effective alternative lower level of care settings for patient care in accordance with the patient's medical necessity, stability, the patients' preferences and health plan benefits.
• Identifies timely post-hospital needs and arranges for services as appropriate.
• Provides patient and family appropriate resources and/or referrals.
• Makes timely and appropriate referrals to, and seeks consultation with others when needed, the patient-centered provision of services; such as Social Services (i.e., Durable Power of Attorney).
• Reviews medical necessity utilizing medical staff-approved evidence-based decision support criteria to determine appropriate level of care and length of stay.
• Ensures utilization review is completed and documented concurrently, and provided to the patient's payer as required.
• Ensures timely escalation of unresolved care coordination issues to the appropriate level.
• Enters delays in service and avoidable days regarding exceeded payer LOS variances.
• Communicates denials and physician related utilization management practices to immediate supervisor same day as identified.
• Collaborates with patients/caregivers to set goals consistent with physician treatment plans, and patient resources and choices.
• Collaborates with the multidisciplinary team for timely discharge planning assessments and reassessments and documents concurrently in the patient's medical record in compliance with hospital policy and all regulatory agencies.