RN Case Manager - Monroe

About the role

This job handles multi-disciplinary communications and facilitations of care throughout a patient’s hospitalization, which includes a review of the appropriate utilization of resources, balanced with the patient’s right to self-determination. Reviews patient hospitalizations, recommends a level of care that meets medically necessary hospital care criteria, and confirms a clear, specific level of care order and other appropriate documentation in the medical record. May discuss alternative care options with the Emergency Department (ED) physician or attending physician. Works as a liaison and communicates with the patient, caregiver, multi-disciplinary team members as well as post-acute and third-party payers. Collaborates with the care team to develop and implement discharge plans based on patient’s individualized needs.

Responsibilities

• Performs pre-admission, admission, and continued stay reviews as directed per CMS guidelines, commercial payer guidelines, and/or hospital policy.
• Supports the values of service excellence, teamwork and integrity and maintains minimum standards for licensure and strives for personal/professional development.
• Maintains knowledge of the conditions of participation as it relates to utilization review and discharge planning.
• Maintains open communication with all appropriate parties while functioning as a liaison between ED physicians, hospitalists, attending physicians, and physician advisors.
• Leads the oversight and management of the functional and financial outcomes, including coordination and implementation of the discharge plan, during the acute-care hospitalization.
• Adapts behavior to the specific patient population, including but not limited to respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.
• Performs other related duties as required.

Requirements

Education Required - Graduate of an accredited school of nursing. Work Experience Preferred - Bachelor’s degree in nursing. Required - None. Preferred - 3 years of hospital-based experience in discharge planning, case management or utilization review.

Qualifications

Proficiency in using computers, software, and web-based applications. Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals throughout the patient care process. Strong interpersonal skills. Ability to work a flexible work schedule (e.g. 24/7, weekend, holiday, on call availability).

Skills

Knowledge of current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

Benefits

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

Pay

Commensurate with experience.

Schedule

TBD.