RN Case Manager - Acute Rehab

Carle Health•Normal, IL

12h•Onsite

About The Position

To provide a comprehensive approach to case management inclusive of all aspects of the patient's stay including, but not limited to the following key functions: discharge planning and execution of the discharge plan; ensuring proper utilization management requirements of payers are met; identification and capture of key clinical conditions by physician documentation; and institution of actions to support quality and safety initiatives.

Requirements

Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
Certified Case Manager within 2 years - Commission for Case Manager Certification (CCMC)
College Diploma: Nursing
Acute care work experience

Responsibilities

Performs intensity of service/severity of illness/disease specific reviews throughout patient stay.
Applies and documents medical necessity reviews on admission and continued stay
Notifies appropriate parties (physicians, nursing staff, patient, families, and other members of the care team as appropriate) when patients not meeting criteria and initiates measures to mitigate risk (discharge or better documentation to support clinical situation)
Demonstrates accurate documentation of medical necessity reviews
Achieves a 90% inter-rater reliability score related to random audits regarding the use of guidelines and accurate documentation of clinical picture
Assists in denial management mitigation by using Medical Director/E H R
Uses GMLOS to help manage length of stay as well as other criteria to move patient efficiently through continuum of care
Demonstrates ongoing assessment for next level of care and actions to move patient to appropriate level (LTAC, Long term care, Hospice, Home Care etc.)
Communicates with insurance companies to ensure accurate documentation for reimbursement.
Coordinates and submits pertinent documentation to meet medical necessity during patients’ stay.
Collaborates and conducts a comprehensive care plan meeting with patients, family, and interdisciplinary team (IDT) to ensure all discharge needs are met.
Develops individualized discharge care plans in EMR.
Maintains current with changes to Patient Driven Payment Model (PDPM) for maximum reimbursement.
Consistent communication with Managed Care companies regarding continued stay, covered days and any discrepancies.
Notifies appropriate staff of any discrepancies with documentation requirements.
Incorporates input from patient and family to ensure an individualized plan of care is in place to best fit the patient’s needs while on TCC and upon discharge.
Performs and executes discharge planning within the first 24 hours of patient stay
Performs accurate and timely screening of patients for discharge needs
Develops sound and reliable discharge plans incorporating risk for readmission assessment in discharge needs and support structure
Includes all stakeholders in the discharge plan to ensure plan is sound and fully communicated
Ensures assessments and plans documented in EMR and other required documents
Participates in multidisciplinary rounding process as requested
Works collaboratively with all caregivers in the continuum of care to ensure sound and timely discharge plan
Manages LOS and resource utilization
Demonstrates strong understanding and mastery of community resources
Possesses strong discharge planning assessment skills
Communicates well and frequent with patients and families
Performs readmission screens and takes action to mitigate readmission risk (use of post discharge resources, medication planning, etc.)
Ensures referrals to other needed disciplines as deemed by assessments (physical therapy, dietary) are made timely early in stay
Works collaboratively with nursing and other members of the care team, to ensure issues that Case Management identifies, are included in the plan of care
Organizes and leads multidisciplinary care conferences as necessary to facilitate plan of care progression.
Adheres to CMS COP: Discharge Planning
Assist in facilitation of organizational and unit based quality initiatives and documentation in EMR.
Incorporates key quality assessment points with daily rounding on patient load
Institutes corrective actions when opportunities for improvement are noted during rounds or identified via other ways (service recovery efforts or reporting timely to manager or appropriate parties; institution of safety measures if not in place or identified)
Performs screening to see if core measures are met and initiates actions to get required actions or documentation completed (asking responsible party to complete etc.)
Daily use of data to assist with identification of readmission and risk sharing population. Also identified other risks such as falls, wounds, pain etc. Once identified works collaboratively with care team to initiate measures to mitigate risk
Ensures accurate documentation by physician for all components related to CMS Certification both for admission and continued stay
Collaborates with Clinical Documentation Specialist to ensure documentation is present to support diagnosis
Collaborates with RAC/Denial Management Coordinator to ensure documentation of medical necessity is present in medical record, for both admission and continued stay, to assist with mitigating denial management for all payers
Documents all Discharge Planning components accurately in EMR
Assist with documentation in EMR to support quality initiatives
Assist with audits for medical necessity documents as requested