About the position
Working in collaboration with the patient/family/legal representative, social workers, physicians, and interdisciplinary team, the RN case manager is accountable for assessing, coordinating and facilitating patient progression through the continuum of care in an efficient, cost effective manner. The RN Case Manager must achieve this through early assessment of pre-admission level of care, post hospital discharge needs, review of available resource and timely, focused communication with the healthcare team and patient/family/legal representative.
Responsibilities
- Assess, coordinate and facilitate patient progression through the continuum of care.
- Conduct early assessment of pre-admission level of care and post hospital discharge needs.
- Review available resources and communicate timely with the healthcare team and patient/family/legal representative.
Requirements
- Minimum 3-5 years acute care case management experience, with demonstrated skills in utilization review.
- Demonstrated ability to use critical thinking and problem solving skills in facilitating safe and timely patient transitions of care.
- Excellent communication skills and positive interpersonal dynamic in working with a variety of stakeholders across the care continuum.
- Solid knowledge of all insurance plan regulations including CMS/Medicaid to ensure compliance with all required processes and documentation.
- Ability to garner and utilize information effectively to develop and modify patient plan of care.
- Strong analytical ability to interpret patient-related information, evaluate appropriateness of continued stay and/or need for ancillary services, and to reassess discharge planning needs based on daily assessment.
- Ability to successfully utilize industry accepted utilization and or medical management criteria in patient status decision making.
- Self-starter able to function independently within the scope of position and licensure, as well as department policies and established goals.
- Excellent computer skills to accurately document requisite information to support patient status and medical necessity.
Nice-to-haves
- Experience in Meditech and Cerner a plus.
- Denials management a plus.
