RN Per Diem

If you are an existing employee of South Shore Health then please apply through the internal career site.

Requisition Number: R-21680

Facility: LOC
0001 - 55 Fogg Road, 55 Fogg Road, Weymouth, MA 02190

Department Name: SSH Care Progression

Status: Part time

Budgeted

Hours:

0

Shift: Varied Shifts (United States of America)

Under the general supervision of the Case Management Manager, acts as a patient advocate/Case Manager to SSH&EC clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. Looks for opportunities to reduce cost while assuring the highest quality of care is maintained.

Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically-based case management, discharge planning and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.

Works collaboratively with interdisciplinary staff internal and external to the Organization. Participates in quality improvement and evaluation processes related to the management of patient care.

* Commits to working a minimum of 32 hours, with at least 16 hours (in 2 shifts) worked during a night and/or weekend per 4‑week schedule. Also works 1 major summer or winter holiday.

Compensation Pay Range: $59.42 - $86.20

1 – The RN Case Manager is responsible for reviewing the medical record of all observation and inpatient admissions and continued stays to ensure appropriate utilization and delivery of care.

• a. Using Inter Qual Criteria, physician certification, and payor‑specific criteria, assists the physician in determining the medical necessity for observation, admission and continued stays.
• b. Identifies cases daily that fail to meet criteria and refers these cases to appropriate manager or physician advisor for secondary review.
• c. Contacts attending physicians daily on cases that lack adequate documentation warranting acute hospitalization and clarifies for them the necessary clinical documentation required to help support medical necessity.
• d. Contacts the attending physician to notify him/her of decision to issue notice of non‑coverage, explains UR process and insurance coverage requirements, obtains physician written concurrence when necessary (e.g., Medicare patients). Informs the patient and/or next of kin when insurance coverage must be terminated for the current admission and issues the termination letter for the Medicare patient.
• e. Reinstates insurance coverage when patient condition becomes acute and meets criteria again;
  
  Any letters accordingly.
• f. Continues review of all patients using criteria and determines need for continued hospitalization based upon third‑party payor/insurance guidelines.
• g. Provides clinical data/information to contracted third‑party payers while patient is hospitalized to ensure continued
  983 reimbursement and to avoid reimbursement delaysೋಪ within 24 hours of request.
• h. Continues review of all patients using criteria and determines need for continued hospitalization based upon third‑party payer/guidelines.

2 – Plays an essential role in assisting physicians, nursing and staff with accurate determination of a patient’s observation status. The RN Case Manager is an important resource in preventing delayed discharges of observation patients.

• a. Identifies and reviews observation patients to determine растение at correct level prior to 12 PM.
• < Íb. Consults with physicians, nursing, admitting, and outside insurance case managers to determine appropriate status.
• c. Assumes the role of review coordinator for observation services; reviews medical record for appropriateness of status and level of care and facilitates accordingly.
• d. Works with physicians, nursing, staff, patients and families to arrange prompt and safe discharge.
• e. Takes telephone orders from physicians changing patient status from observation to inpatient admission. Must _actively_ monitor patients on observation status and seek…