Case Manager - Per Diem - Day

Hackensack Meridian Health•Brick, NJ

5d•$44

About The Position

The Case Manager provides assessment, care planning and coordination, and advocacy to patients and their families. Assists with the patient flow through the continuum of care in a timely manner. The case manager follows guidelines and regulations according to level of care criteria (Medicare, Medicaid, HMO's, etc).

Requirements

Graduate of an accredited Nursing Program.
Related Case Management and Nursing experience.
Knowledge of CM, Utilization Review Discharge Planning and Coordination of Care.
Excellent computer skills
NJ State Professional Registered Nurse License.

Nice To Haves

5 Years of experience as an RN in an acute care setting.
Familiar with Access programs.

Responsibilities

Evaluates all patients for appropriateness of admission and level of care within 24-48 hours.
Initiates discharge plan within 24-48 hours of admission.
Discusses initial plan of care with MD.
Discusses and reviews initial plan of care with patient/family.
Ensures and follows CMS protocols, IM letters and all HQSI letters.
Documents in all required areas and ensures required documentation elements are all included.
Participates in daily multidisciplinary rounds.
Maintains communication with a multidisciplinary team through the continuum of care.
Provides daily clinical reviews as required.
Maintains ongoing communication with physicians and patients/families to ensure plan of care is appropriate and expedited.
Ensures clinical reviews are communicated to insurance companies to ensure payment.
Refers cases, as needed, to physician advisor, denials team and/or other appropriate team members.
Manages denials concurrently and communicates and documents all outcomes and actions taken.
Communicates identified issues to appropriate departments for problem resolution using variance tracking.
Actively participates and assists in departmental PI goals and patient satisfaction initiatives.
Other duties and/or projects as assigned.
Adheres to HMH Organizational competencies and standards of behavior.