Care Manager Rotation Schedule WJMC

LCMC Health•New Orleans, LA

12d•Onsite

About The Position

Your job is more than a job. At LCMC Health, we value the unique qualities each person brings to work, recognizing that these 'little extras' contribute to extraordinary outcomes. We foster a culture that supports and celebrates the extraordinary, evident in our facilities and our people. Every patient healed, every family comforted, and every life improved is a testament to these collective efforts. Join LCMC Health and discover how our everyday environment makes it easy to live your extraordinary life.

Requirements

2 years Nursing experience in clinical area
Current LPN Louisiana License.

Responsibilities

Coordinates written/verbal communication relating to the medical treatment plan (patient/family/physician/other care team members) and communicates the treatment plan to external agencies, as needed.
Assists with organizing services across provider lines, between people, and systems to affect optimal patient outcomes, achieve continuity of care and reduce costs.
Uses daily worklist to review payer source, patient information, physician information, etc. from hospital systems.
Prioritizes cases according to financial reimbursement and clinical criteria.
Works cohesively with the interdisciplinary team and appropriate nursing staff in the coordination of the transitions in levels of care or discharge planning.
Establishes a rapport with physicians and interacts face to face or telephonically with physicians/NPs to discuss plan of care, documentation, clarification, and obtain orders to consult and or transfer patients through the continuum as appropriate.
Provides ongoing follow up with patient/caregiver. Telephonically evaluates patient conditions and provides follow up based on needs identified.
Obtains pre-certification of post-acute care when required.
Informs the attending/primary care physician, nursing staff, patient/caregiver of post- acute care services denied by insurance providers and rights to appeal when applicable.
Maintains a current list of resources for referrals and refers to the appropriate inpatient, outpatient and community resources.
Maintains working knowledge of Medicare, Medicaid, private insurance company coverage for referred products and services.
Collaborates with physicians, caregivers, patient/family, other departmental team members, payor to proactively develop and implement a safe, timely and appropriate discharge plan.
Identifies resource consumption patterns and suggest alternatives to meet patients' needs to the attending or other members of the healthcare team.
Provides feedback to physicians regarding practice pattern issues and documentation to substantiate (IS/SI) severity of illness.
Able to screen patients at intake such that appropriate post-acute level of care is determined initially.
Obtains appropriate documentation and data to support patients discharge plan.
Utilizes the nursing process to coordinate the care of patients discharged by LCMC and referred emergency department patients.
Interacts with the nursing staff/care coordinator staff when needed the physician, patient/family and other healthcare team members to formulate a discharge plan pertinent to the patient's physical, psycho-social and financial parameters.
Reviews and discusses with patient/care giver(s) discharge instructions including red flag indicators, medications, follow up appointments and follow up care.
Facilitates the patient's discharge plan while utilizing opportunities to maximize cost-effective, quality care.
Interacts daily with all health team disciplines involved in the patient's care in order to identify issues or obstacles in progress toward treatment plan goals and facilitates problem solving and revision of discharge plan if necessary.
Manages cases on a daily basis to avoid denials and documents reasons for discharge delays and avoidable days in hospital information system.
Sets up doc-to-docs and provide pertinent information to appeal any denials, refers cases for appeal and assist with history of case.
Maintains a working knowledge of electronic discharge program and utilizes it for documentation of discharge arrangements.
Identifies and coordinates resources needed to ensure continuity of care which may include arranging transportation, medication assistance, home health, durable medical equipment, hospice, palliative care or social services support.