Case Manager (Full-Time)

Larkin Community Hospital•Hialeah, FL

About The Position

Responsibilities: Performs and documents patient assessment within 24 hours of admission Checks prior authorizations initiative by admitting Knowledge navigating and using payer portals Performs concurrent reviews Contacting all HMO’s on a daily basis and provides clinical information to obtain insurance authorization for the patient’s admission and continued stay Indicates the appropriate level of care and utilization of services needed Establishes criteria for medically necessary services Knowledgeable of Milliman Care and Interqual Guidelines Develops a plan of care for patients from admission to discharge. Promotes the most efficient and cost-effective use of services Curtails the performance of inappropriate and/or duplicate services Encourages standardization of medical practice patterns Enhances the quality of healthcare Performs concurrent reviews for patients to ensure that extended stays are medically justified and are documented in patient's medical records. Calculates and manages the lengths of stay and continued-stay days for patients. Evaluating the patient’s condition and readiness for discharge planning Develops discharge plans Communicate and assist the physicians in the planning and coordination of patients discharge planning Management of transfer procedures Management of the guardianship process Able to discuss and educate patient/family regarding discharge planning and resources available after discharge. Clearly specifies all the information discussed with the patient and/or family regarding the patient’s discharge plan. Participates in PI programs through the identification of opportunities for improvement, data collection, evaluation of findings, improving the process, applying knowledge and incorporates into practice Scheduling Peer-to-Peer reviews with payors Proactively identifying and resolving issues that could lead to denials

Requirements

Previous C.M. Experience
Substantial clinical experience
Bachelor's degree
Familiarity with Medhost electronic medical records
Extensive medical knowledge
Self-driven (work and education)
Keeps knowledge up to date by reading literature and participating in outside continued education meetings, training, and conferences
Working knowledge of regulatory agencies
Excellent human relations and communication skills (verbal and written) to maintain good rapport and effective working relationships with medical staff, nursing staff, and other ancillary department staff throughout the hospital
Excellent organizational skills and attention to detail
Ability to convey care plan to physicians and the medical team
Proficient with Microsoft Office Suite or related software.
Integrity

Nice To Haves

Masters
Foreign Medical Graduate or Registered Nurse
CCM (Certified Case Manager)
ACM (Accredited Case Manager)
Bilingual (English/Spanish)

Responsibilities

Performs and documents patient assessment within 24 hours of admission
Checks prior authorizations initiative by admitting
Knowledge navigating and using payer portals
Performs concurrent reviews
Contacting all HMO’s on a daily basis and provides clinical information to obtain insurance authorization for the patient’s admission and continued stay
Indicates the appropriate level of care and utilization of services needed
Establishes criteria for medically necessary services
Knowledgeable of Milliman Care and Interqual Guidelines
Develops a plan of care for patients from admission to discharge.
Promotes the most efficient and cost-effective use of services
Curtails the performance of inappropriate and/or duplicate services
Encourages standardization of medical practice patterns
Enhances the quality of healthcare
Performs concurrent reviews for patients to ensure that extended stays are medically justified and are documented in patient's medical records.
Calculates and manages the lengths of stay and continued-stay days for patients.
Evaluating the patient’s condition and readiness for discharge planning
Develops discharge plans
Communicate and assist the physicians in the planning and coordination of patients discharge planning
Management of transfer procedures
Management of the guardianship process
Able to discuss and educate patient/family regarding discharge planning and resources available after discharge. Clearly specifies all the information discussed with the patient and/or family regarding the patient’s discharge plan.
Participates in PI programs through the identification of opportunities for improvement, data collection, evaluation of findings, improving the process, applying knowledge and incorporates into practice
Scheduling Peer-to-Peer reviews with payors
Proactively identifying and resolving issues that could lead to denials