Case Manager RN - Case Management (Full Time, Days)

Franciscan Missionaries of Our Lady University • Jackson, MS

73d

About The Position

The Case Manager directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager 1 specializes in the review of information pertaining specifically to the assigned areas. Relies on education, experience, professional training and judgment to accomplish responsibilities. A wide degree of creativity and latitude is expected. Works under minimal supervision. Directs the utilization review of patient charts and treatment plans pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager of Clinical Services specializes in the review of information pertaining specifically to the assigned area (i.e.: Case Management, Geriatrics, Mental & Behavioral Health, Home Health). Most, but not all, of the accountabilities below may apply to each specific area.

Requirements

• Graduate from an accredited school of nursing, RN.
• Minimum of two years' clinical experience required.
• Case management or Utilization management experience preferred.
• Employee must demonstrate ability to recognize patients' individual needs based on medical conditions, age (infants, pediatrics, adolescents, young adults, middle-aged and geriatric), limitations and planned procedures.
• Requires oral and written communication skills; professional affiliations.
• Current Mississippi RN license required.

Responsibilities

• Contributes to cost effectiveness/efficiency and demonstrates awareness of benefit system and cost benefit analysis.
• Demonstrates the ability to maximize financial outcomes of assigned patient load using the continuum of care philosophy.
• Assists in the development, monitoring, and analysis of annual financial goals of targeted population.
• Understands the capabilities of outside referral sources such as home health, sub-acute care and skilled nursing facilities.
• Meets with treatment team to provide utilization review information, discusses issues pertaining to continued stay, discharge and aftercare plans.
• Performs effective utilization review techniques to work with physicians, third party payors, and federal and local agencies to prevent denials of payment or days.
• Acts as a resource for unit personnel in the resolution of utilization/case management problems.
• Collaborates with all members of the health team to ensure reimbursement optimization, appropriate discharge planning, and cost-effective quality care.
• Plays a key role in the discharge planning process assessing patient's needs for referrals and/or alternate levels of care.
• Evaluates the quality of necessary medical services, utilizes criteria to determine medical necessity of admission.
• Provides appropriate and timely information to third party payors to facilitate financial outcomes.
• Demonstrates ability to access and utilize community resources.
• Observes and adheres to all departmental and hospital policies and procedures.
• Promotes the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise.
• Performs other duties as assigned or requested.

What This Job Offers

• Education Level: Bachelor's degree