Rn Case Manager; Prn Job Springfield Georgia USA,Nursing

Benefits

Retirement plan 403 (b) and 457
Health insurance
Dental insurance
Vision insurance
Prescription Drug Plan
Hospital Discount
Flexible spending account
Paid time off
Extended Days off (Sick time)
Employee assistance program
Strive
365 Wellness Program
Basic Life insurance (Employer Paid)
Voluntary Life insurance/Accident/Critical Illness
Disability (LTD and STD)
Tuition reimbursement
Legal and d
Discounted Gym membership
Cafeteria Payroll Deduction
Employee Perks Program
Student Loan Relief and Assistance
Employee Rewards and Recognition Program
Bereavement Leave

Job Summary

Under the general direction of the Director of Transitional Care, the RN Case Manager is accountable for a designated patient caseload and plans effectively to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Case Management is a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates options and services required to meet the patient’s health and human service’s needs.

It is characterized by advocacy, communication, and resource management, and promotes quality and cost-effective interventions and outcomes in accordance with The Joint Commission, federal, state and local guidelines.

The position requires a solid knowledge base, critical thinking skills, and ability to apply evidence-based guidelines are crucial in addition to excellent interpersonal skills, self-motivation and strong organizational skills to function in a semi-autonomous role within a fast paced and dynamic environment.

Job Qualifications

Minimum Level of Education
:
Must be a graduate of an accredited School of Nursing with an Associates degree or bachelor’s degree in nursing.

Formal Training
:
Management skills with experience in planning, organizing, implementing, facilitating, interviewing, counseling, and verbal and written communications.

Licensure, Certification, Registration
:
Must have and maintain an unencumbered license/Certification as a Registered Nurse with the State of Georgia or compact license and maintain a BLS CPR certification.

Work Experience
:
Minimum of two years acute hospital nursing experience required; (2) two years acute hospital Case Management experience preferred. Utilization review experience preferred with MCG or Inter Qual guidelines;
Intermediate computer skills with word processing and spreadsheet capabilities.

Standards of Performance

Admission review and continued stay reviews of patients using evidence based clinical based guidelines (Milliman).

Contacting insurance companies to provide clinicals to support admissions/continued hospital stays.

Referring cases to the Physician Advisor for further review and collecting QA and Avoidable Days data as directed.

Function as an integral member of a collaborative and interdisciplinary team, to re-assess and adjust the plan for care progression and transition according to the patient’s clinical condition.

Provides federal notices to Medicare beneficiaries per federal guidelines and hospital policy.

Supports Nursing Services and other clinical and non-clinical ancillary services in assuring the continuum of care for patients and in maintaining the quality of service delivery.

Serve as a patient advocate in appropriate utilization of benefits and community resources.

Completes and documents timely clinical reviews based on assessment of medical necessity and documented clinical findings in accordance with hospital policy and payer findings.

Demonstrates understanding of medical necessity and intensity of service and incorporates payer requirements into development of safe, effective and timely discharge plan.

Incorporates risk of re-admission and socio-economic factors in the creation of a safe and individualized…