Case Manager-Case Management

The Methodist Hospitals•Merrillville, IN

6h•Onsite

About The Position

The Case Manager is responsible for chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. They monitor the care of assigned patients to assure quality, cost-effective utilization of resources, and optimal outcomes. The role involves coordinating the patient's plan of care from admission to discharge and/or transfer to another level of care.

Requirements

Knowledge of appropriate and timely return transition levels of care.
Knowledge of CARF, Regulatory Agencies and State Board of Health, Long Term Care, Acute Care and Ambulatory Care Standards.
Excellent interpersonal and problem-solving skills.
Self-directed, goal-oriented, and customer service-focused.
Excellent organizational and prioritization skills to meet deadlines.
Capable of functioning effectively across service lines.
Ability to assess and interpret data about the patients status in order to identify each patient's age, specific needs and provide the care needed by the infant, child, adolescent, young adult, middle adult and geriatric patient.
Ability to independently perform comprehensive chart review with subsequent abstraction of relevant information including interpretation of lab results, EKG and other medical tests.
Ability to communicate effectively both verbally and in writing.
Ability to provide compassionate patient care, oriented with an effort for timeliness and accuracy in the delivery of service.
Ability to respond positively to the needs of patients and family.
Addresses customer concerns in a private, respectful, and calm manner.
Associates Nursing Required
3 years Acute Care experience Required
Active Licensed Registered Nurse
Basic Life Support Certification
Demonstrates knowledge of procedures for protecting and maintaining the security, confidentiality, and integrity of employee, patient, family, organizational, and other medical information.
Understands and supports the commitment of Methodist Hospitals in adhering to federal, state, and local laws, rules, and regulations governing ethical business practices for healthcare providers.

Nice To Haves

Bachelors Nursing Preferred

Responsibilities

Applies knowledge of third-party payer regulations that govern admissions, continued stay, and discharge to individual cases through chart review.
Collects data related to clinical improvement initiatives for the purpose of developing action plans.
Conducts concurrent chart reviews to assure complete and accurate medical records documentation.
Coordinates the patient's plan of care with all members of the health care team, including the patient, caregiver, family members, and case management.
Demonstrates proficiency in patient assessment and documentation.
Interviews and assesses patients to determine potential barriers to timely discharge/transfer to another level of care.
Provides all payers with accurate, updated information.
Obtains covered stay certification and prior authorization as appropriate.
Refers cases to the physician advisor when appropriate for medical necessity, continued stay, physician education, and appropriate level of care.
Refers to Social Services when appropriate.
Ensures discharge planning to the appropriate level of care, sub-acute, hospital units, and outpatient services.
Supports hospital CQI programs by participation on relevant teams.
Performs other duties as needed and/or assigned.