RN Case Manager

Dardanelle Regional Medical Center•Dardanelle, AR

About The Position

Provides discharge planning and utilization review services in compliance with patients’ discharge planning needs and the hospital’s utilization review program. Coordinates and manages the facility’s Swing Bed program and coordinates the Employee Health program. This is designated as a Safety Sensitive Position under Act 593 of the State of Arkansas. The role includes case management for acute care patients, utilization review and medical-necessity review, coordination of Swing Bed referrals and transitions, and administration of Employee Health activities. The position participates in weekend call rotation for nursing management and performs other duties as assigned by management.

Requirements

Registered Nurse licensed to practice in Arkansas.
Maintain Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS).
Excellent written and verbal communication skills, including computer knowledge.

Nice To Haves

At least one year of experience in case management or utilization review is preferred.

Responsibilities

Serve as a liaison between patients, families, physicians, and other health care personnel.
Responsible for discharge planning for all Acute Care patients and conduct Discharge Planning Meetings in accordance with Arkansas Department of Health rules and regulations.
Collaborate on utilization review of Acute Care patient services and participate in appropriate department and hospital committees and meetings.
Investigate and resolve complaints or refer issues to the appropriate Manager or Director.
Maintain positive relationships with other Case Managers and contacts at area facilities.
Develop and implement quality-improvement data, and report data to leadership and the quality council.
Respond promptly to case management and utilization review questions and issues; collaborate on problem-solving and share information in a timely manner to support common goals and customer needs.
Adhere to the Compliance program and maintain knowledge of CMS utilization review requirements and community resources related to discharge planning.
Review medical records and maintain them in accordance with Medical Information policies.
Analyze patient information to determine medical necessity for admission or continued stay; review admission medical necessity on the first working day after admission using approved review criteria.
Review inpatient procedures to determine appropriate utilization and acuity level.
Perform retroactive reviews as needed and respond to review agencies or third-party payors.
Research denials from review agencies and third-party payors and submit responses within specified appeal time frames.
Participate in the weekend call rotation for nursing management.
Coordinate Swing Bed admissions and referrals from initial referral through admission and discharge.
Serve as the primary contact for hospitals, discharge planners, case managers, physicians, patients, and families regarding Swing Bed referrals.
Review referrals and gather required clinical, demographic, insurance, and other admission information.
Coordinate with nursing, therapy, dietary, billing, and other departments to facilitate timely admissions.
Monitor referral status and promptly follow up on pending referrals and potential admissions.
Assist with insurance verification, prior authorization, and other payer requirements as applicable.
Maintain timely and accurate documentation of referrals, admissions, and patient transitions.
Track Swing Bed census, referrals, admissions, discharges, and referral outcomes.
Develop and maintain professional relationships with hospitals, physicians and physician offices, discharge planners, case managers, social workers, home health agencies, hospice providers, and other referral sources.
Communicate the facility’s Swing Bed rehabilitation, nursing, and other applicable services to referral sources and the community.
Work with leadership to develop and implement census-building and community outreach strategies.
Coordinate the Employee Health program for DRMC and coordinate its policies and planning with hospital leadership, infection prevention, pharmacy, other departments, and relevant external agencies.
Coordinate required employee health vaccinations, immunizations, and post-exposure prophylaxis.
Conduct personnel health assessments as needed to evaluate work-related illness or exposure to infectious diseases.
Investigate, assess, and follow up on work-related injuries and illnesses; assist employees in obtaining medical care as needed.
Maintain personnel health records, including screening information, immunization records, test results, and reports of work-related illnesses, injuries, or exposures, in accordance with state and federal requirements.
Ensure Employee Health policies are current and revised annually, and adhere to applicable local, state, and federal regulations.
Notify the Infection Prevention Nurse of personnel infections requiring work restrictions or exclusion, work-related infections and exposures, and clearance to return to work after an infectious illness requiring restrictions or exclusion.
Perform other duties and responsibilities as assigned by management.