Registered Nurse, RN | Case Manager

POSITION SUMMARY

Relocation Assistance available up to $15,000. Pay range: $49.53/hr - $74.79/hr.

Analyzes patient medical records concurrently and/or retrospectively for quality assessment and discharge planning criteria. Provides supportive documentation and clinical records to insurance carriers for authorization of services. Coordinates discharge plans and orders for patients leaving the hospital including identifying needs for community services and making appropriate transition plans. This position requires creativity and problem solving, multi-tasking, and the ability to prioritize tasks and work with minimal supervision.

Performed majority of the time:

• Applies and shares knowledge of community health and social service resources.
• Evaluates medical information and completes discharge needs assessments within 1 day of admission as set by established criteria, to identify patients that are at high risk of requiring post-hospital services, and the need for case management and discharge planning intervention.
• Initiate and complete safe discharge plans for inpatients by arranging Home Health referrals, complex drug therapy interventions, outpatient clinic visits, skilled nursing placements, intermediate care placements, assisted living arrangements, etc.
• Documents initial assessment of the patient and continually assesses discharge needs through the continuum of care.
• Works closely with external vendor partners to arrange post-discharge needs, maintains amiable and professional relationship with vendors at all times.
• Assesses variables that impact health and functioning, interprets clinical information and assesses implications for treatment.
• Issues Important Messages from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), and denial of services letter following appropriate health plan or Medicare guidelines.
• Collaborates with Hospitalists and Multi-Disciplinary team daily to facilitate the timely discharge of patients from the hospital setting.
• Enter Avoidable Days and Code 44 Documentation when appropriate.
• Provides information to patients and families on “Advanced Directives” when requested.
• Responds to outpatient and community questions and referrals.
• Screens patient’s medical records concurrently and/or retrospectively using pre-established screening criteria for quality assurance and discharge planning.
• Facilitates discharge planning for the continuum of care.
• Facilitates placements or referrals as appropriate to meet the patient’s clinical needs/rights and are specific for neonate, infant, pediatric, adolescent, adult and geriatric populations.
• Reports suspected abuse, neglect, or unsafe discharge environment to the appropriate agency.
• Develops an individualized case management plan that addresses physical, vocational, psychosocial, age, cultural, financial and educational needs and documents case management activities.
• Coordinates the appropriate services and resources needed.
• Communicates with patient/family/significant others and all multi-disciplinary team members for appropriate post-hospital services/needs.
• Consults with the social worker to identify appropriate social service needs.
• Provides insurance carriers with necessary information to authorize follow-up care when necessary and obtains pre-authorization for post-discharge services including Skilled Nursing, Durable Medical Equipment, Home Oxygen, or Rehabilitation.
• Relays pertinent information to the Case Management Manager to represent Case Management with internal medical or quality committees, inpatient nursing staff, ancillary provider staff as appropriate.

Performed occasionally but critical to successful performance of the job:

• Attends scheduled staff, care conferences, and other meetings as appropriate.
• Attends Utilization Review Committee meetings as schedule allows.
• Shares information from seminars and other sources of education with others as appropriate.

• Education: Associates Degree in Nursing
• Experience: Associates Degree in Nursing must have 3 years’ experience practicing as an RN;
  Bachelor or Master of Science in Nursing must have 2 years’ experience practicing as an RN
• Licens…