Case Manager RN - Our Lady Angels

Case Manager RN - Our Lady of the Angels

4 days ago – Be among the first 25 applicants.

• Evaluation and Analysis
• Performs admission review for appropriateness using established Interqual criteria within 24 hours of admission/next working day.
• Monitors care/services provided to assigned patient population for potential opportunities for improvement or possible deviation from standards of care, protocols, and/or completion of core measure pathways.
• Reviews current treatment plans daily to evaluate appropriateness of services and progress toward treatment goals.
• Assesses patients for needs on initial and concurrent reviews.
• Identifies appropriate referrals for assistance with plan information. Initiates Social Service referral for those patients having complex or high risk discharge needs or further assistance with plan formation. Notifies staff/physician and payors of discharge plan and needed action to implement.
• Partnership and Collaboration
• Notifies all involved entities when admission fails to meet criteria for admission and immediately documents information.
• Assists physicians with additional documentation when patients' level of care changes.
• Immediately notifies Business Office of category changes.
• Actively participates and leads the Interdisciplinary Discharge Planning Meetings.
• Communicates with the Case Management Team on patient's status, treatment plan and goals.
• Serves as a liaison between hospital providers, family, patient, and physician by working to resolve issues in an efficient manner while keeping the patient's best interests in mind.
• Notifies physicians of need for additional documentation or adjustments to treatment plan to promote continuum of care. Make suggestion to staff and physicians to optimize efficiency of services provided and minimize consumption of resources. Readily available as a resource for all disciplines.
• Notifies payors of admissions and discharges per protocol. Communicates accurate information with payor and physician to ensure coverage for services/care provided. Immediately notifies physicians and Business Office if potential non-coverage issues evolve. Actively works to maintain or gain coverage for patient.
• Acts as an information and referral source by developing cooperative agreements with community agencies and services in an effort to meet patient needs and ensure that treatment is immediately relevant to the problems the patient is experiencing.
• Documentation & Quality
• Maintains monthly discharge documentation and CM statistics and submits required data by deadlines. Tracks avoidable days and denials.
• Completes fall-out sheet for peer review in a timely manner.
• Fosters an organizational climate that supports and promotes effective performance improvement efforts.
• Promptly notifies AVP or Manager of Medical Management of possible quality issues.
• Maintains highest level of confidentiality at all times with dealing with patients, staff or physician issues.
• Ensures that appropriate priority is given to provide high quality care by ensuring guidelines are followed for core measures through concurrent chart review and follow-up with appropriate healthcare provider.
• Conducts concurrent appeals and notifies AVP or Manager of all denials for tracking in a timely manner.
• Employee shall conform to regulatory, customer and organizational requirements.
• Document results of review, prepares fallout sheets and notifies appropriate personnel. Notifies physicians of need for additional documentation or adjustments to treatment plan to promote continuum of care.
• Other Duties as Assigned
• Adheres to hospital policy on the usage of Paid Time Off and Extended Illness Time.
• When requested, adjusts personal schedule to meet department/unit needs.
• Reports to work on time, and if necessary, reports tardiness to appropriate person.
• Utilizes time to accomplish work in an efficient manner.
• Maintains a professional appearance, according to job requirements, at all times.
• Attended all required mandatory educational sessions.
• Operates equipment and performs job-related duties in a safe manner.
• Responds appropriately to fire, safety and disaster situations.
• Utilizes Personal Protective Equipment…