Case Manager (Maternal Child)

Renown Health•Reno, NV

About The Position

The Case Manager is a clinical position that collaborates with an interdisciplinary team to assess, plan, implement, coordinate, monitor, and evaluate care options and services. The role promotes appropriate utilization of care, cost-effective outcomes, timely and appropriate delivery of services, and appropriate discharge planning and length of stay. It includes reviewing medical records and working to reduce or eliminate avoidable days. Case management spans the healthcare continuum, from the pre-acute phase through post-acute care. The Case Manager assesses premorbid health status, current medical conditions, and post-acute needs, and also performs Utilization Management responsibilities, including an initial utilization review assessment within 24 hours of admission and concurrent continued-stay reviews. The Case Manager consults with and educates the interdisciplinary team about alternative levels of care and managed-care issues, and provides physicians with information such as certified length of stay and reimbursement issues to support timely disposition to the next level of care. The Case Manager monitors and documents progress toward the care plan, revises it as needed, and supports smooth transitions at discharge. The position advocates for clients’ informed choices and self-determination while respecting their beliefs and values. It documents reviews and potential avoidable or non-reimbursed days, communicates quality indicators, delivers non-coverage letters as required, maintains knowledge of post-acute admission criteria, and participates in Quality Improvement initiatives. This position does not provide patient care.

Requirements

Working-level knowledge of English, including reading, writing, and speaking.
Education appropriate to obtain and maintain a State of Nevada Registered Nurse license.
Ability to obtain and maintain a State of Nevada Registered Nurse license.
Proficiency with Microsoft Office Suite, including Outlook, PowerPoint, Teams, Excel, and Word.
Ability to use a computer for online learning requirements, accessing online forms and policies, and completing online benefits enrollment.
Excellent documentation and communication skills.
Ability to use critical thinking, find solutions quickly, and escalate when services or care are not delivered efficiently or appropriately.

Nice To Haves

Bachelor of Science in Nursing.
One year of experience as a registered nurse.
Case Management, post-acute, and/or UR/QA experience.
National Certification in Case Management (CCM) or Accredited Case Manager (ACM) certification.

Responsibilities

Conduct an initial assessment for patients with a Case Management consult within 24 hours of admission, identifying anticipated post-acute needs and potential barriers.
Participate in interdisciplinary discharge rounds (IDDRs), presenting GMLOS, ALOS, the anticipated discharge plan, and discharge barriers.
Promote progression of care using evidence-based clinical guidelines, such as InterQual.
Facilitate a discharge plan based on clinical needs and available resources, including needs such as a wound vac.
Ensure post-acute referrals are entered in the EMR and the discharge plan is documented there.
Obtain choice forms as needed and ensure IMMs are signed 48 hours before discharge.
Ensure the care team agrees on the discharge plan, discharge date, and care-transition plan.
Review the EMR and ensure appropriate DME orders and Face to Face documentation are completed.
Ensure discharge summaries are written and available in the system in time for discharge.
Ensure tests, including lab work, imaging, and surgery, are scheduled timely and escalate issues as needed.
Work to prevent length of stay from exceeding calculated GMLOS and ensure the care team is working toward timely discharge.
Coordinate discharge planning for clinically complex cases, including wound vacs, IV medications, and medications requiring pre-approval.
Respect clients’ beliefs and values while advocating for their right to self-determination and informed choices.
Document chart and phone reviews; identify, document, and communicate potentially avoidable or non-reimbursed days and quality indicators such as readmissions.
Deliver non-coverage letters as required by payer or regulatory compliance.
Maintain knowledge and competencies related to the position, including post-acute admission criteria for rehabilitation, LTAC, and SNF settings.
Participate in Quality Improvement initiatives and align practice with the Integrated Health System’s mission, vision, and goals.