LVN- Case Manager - Ambulatory Care - Hybrid

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• Meets with patients within 24 hours of admission and conducts an initial assessment.
• Consults with assigned hospitalist each day during morning rounds regarding disposition planning and appropriateness for each day of patient’s stay.
• Reviews with hospitalist the patient’s admission and continued stay for medical necessity, appropriateness of care and level of care. Use Milliman and Interqual guidelines as necessary.
• Begins discharge planning and care assessment within one working day (preferably on day of admission).
• Submits necessary clinical information to the health plan using the accepted format (MIDAS or telephonic) and coordinate health plan communication with assigned hospitalist as appropriate.
• For patients who are transitioning to the Skilled Nursing Facilities, refers to nurse practitioner and case manager assigned to the SNF’s for continued review and follow up.
• Authorizes all appropriate services based upon covered benefits and necessity of care provided.
• Coordinates discharge planning and alternative treatment plans with PCP/hospitalist/specialist as appropriate.
• Coordinates the patient’s care with other health care personnel to ensure that the patient receives care timely post discharge.
• Secures outpatient follow-up appointments and scheduling tests or outpatient procedures with appropriate health care providers.
• Refers to Ambulatory Case Manager patients identified that will need oversight of outpatient care and compliance to avoid unnecessary readmissions.
• Coordinates referrals and secure appointment with various CSMNS disease management programs.
• Enters and updates all authorization and clinical information into Nautilus (Access Express) no later than date of discharge.