Case Manager RN (Temporary, Remote. Day shift)
About The Position
The Case Manager RN conducts utilization reviews using MCG criteria, promotes appropriate use of resources, and participates in Case Management Department initiatives. The role reviews admissions for appropriateness by the first business day following admission, including concurrent and retrospective reviews regardless of insurance coverage or a patient’s ability to pay. It provides initial clinical reviews to commercial insurers when indicated and contacts the Physician Advisor when review criteria are not met. During hospitalization, the Case Manager monitors the patient’s electronic medical record to determine whether continued stay is appropriate and completes continued-stay reviews in AllScripts at least every third business day. The role identifies factors delaying discharge and facilitates their correction. Case Management documentation in the EMR supports peer review and patient care evaluation studies. Each entry must be identified as a case management note and electronically signed when documented; progress notes should be clear, specific, and use abbreviations only in accordance with hospital policy.
Requirements
- Bachelor’s degree in social work or a related field.
- At least 2 years of related experience.
- Excellent interpersonal and communication skills.
Responsibilities
- Conduct utilization reviews using MCG criteria.
- Promote appropriate utilization of resources.
- Participate in and support Case Management Department initiatives.
- Determine when an admitted patient does not meet inpatient criteria, including Medicare Code 44/observation cases.
- Escalate level-of-care concerns to the Case Management Director and/or Physician Advisor.
- Coordinate with Patient Access to obtain and monitor timely notices of admission for clinical review.
- Review admissions for appropriateness by the first business day following admission, including concurrent and retrospective reviews regardless of insurance coverage or ability to pay.
- Provide initial clinical reviews to commercial insurance companies as indicated.
- Contact the Physician Advisor when review criteria are not met.
- Monitor patients’ electronic medical records to determine continued-stay appropriateness.
- Complete continued-stay reviews in AllScripts at least every third business day.
- Identify factors delaying discharge and facilitate their correction.
- Document case management activity in the EMR using properly identified, electronically signed, clear, and specific entries that conform to hospital policy.
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What This Job Offers
Job Type
Full-time
