NM - Utilization Review + Swing Bed Case Manager

Acute Care RN Case Manager

This position is responsible for:
Routine case management, discharge planning, swing bed coordinator and utilization review duties. Evaluating and screening potential admissions to the facilities swing bed program knowledgeable of criteria for Medicare, Medicaid, HMO, swing bed and private insurance coverage Initiate ongoing communication with the resident and resident's family to assess discharge needs. Actively involvement in daily rounds with bedside staff, physicians and ancillary team members Communicate with physicians to ascertain their plans for a timely discharge.

document updates and discharge planning as an ongoing review. Manage and collaborate with the healthcare team on swing bed placement and complete MDS documentation as necessary. assist with obtaining referrals, prior authorization for Home Health Care, CME, SNF, acute rehab and appointments. Educates physicians and staff regarding appropriate level of care/utilization and required documentation that meets admission status Run Interqual for each IP and OBS patient admitted to the floor

Shift:

Specialty Type:
Mid-Revenue Cycle Solutions

Sub Specialties:
Acute Care RN Case Manager – Discharge Planning, Acute Care RN Case Manager – Util Rev/Appeals & Denials, Acute Care RN Case Manager – Util Rev/Discharge Planning, Acute Care RN Case Manager – Utilization Review

General

Certifications:

N/A