Case Manager - PRN

FLSA STATUS

Non-exempt

• Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certificates, Licenses and Registrations section.

• Three (3) years hospital clinical nursing experience which includes two (2) years in case management

• RN - Registered Nurse - Texas State Licensure - Texas Board of  Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations.
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.
• Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
• Knowledge of Medicare, Medicaid and Managed Care requirements
• Comprehensive knowledge of community resources, health care financial and payer requirements/issues, and eligibility for state, local and federal programs
• Comprehensive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources.
• Ability to work independently
• Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
• Demonstrates critical thinking and makes decisions using evidence-based analytical approach in interactions with physicians, payors, and patients and their families
• Well versed in computer skills of the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint and Word)

• Collaborates with the physician and all members of the interprofessional health care team to facilitate care for designated case load; monitors the patient’s progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective; facilitates timely completion and reporting of diagnostic testing; completion of treatment plan and discharge plan; modification of plan of care, as necessary, to meet the ongoing needs of the patient;
  
  assignment of appropriate levels of care; completion of all required documentation in EPIC and MIDAS.
• Serves as a preceptor, as appropriate, and implements staff education specific to patient populations and unit processes; coaches and mentors other staff and students. Serves a resource for case management and social work resources and needs for the department and the hospital.

• Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance. Identifies when services no longer meet Inter Qual/Millman I criteria, initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician advisor, if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage.
• Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay. Reviews level of care denials to identify trends and collaborate with team to recommend opportunities for process improvement.

• Documents assessment and interventions efficiently and effectively.
• Plans for routine/difficult discharge and anticipates/prevents and manages emergent situations. Specific focus given to discharge plan and elimination of barriers.
• Performs…