RN Case Manager (8A-4:30P)

Jackson County Hospital District•Marianna, FL

About The Position

The RN Case Manager performs preadmission, admission, continued-stay, and retrospective reviews, as well as observation tracking, in a timely and orderly manner. The role applies working knowledge of InterQual level-of-care criteria and Medicare, Medicaid, managed-care DRG assignment, and private insurance requirements based on pre-established contracts. Potentially inappropriate admissions, unnecessary continued days, and procedures that do not meet approved indications are referred to the Case Manager Director for Physician Advisor review. The Case Manager also participates in process improvement activities aimed at improving utilization and compliance. The position assesses Medicare, Medicaid, and high-risk patients to identify discharge-planning needs and documents assessments and planning on an ongoing basis. It communicates with physicians, patients, and families to support discharge planning and facilitate post-hospital care. The Case Manager identifies appropriate assistance, settings, and resources; coordinates home-care needs, ideally completing arrangements 24 hours before a known discharge date; and provides referrals and support, including for Advanced Directives, social work, and Pastoral Care when appropriate. The role works collaboratively with the Case Management team, providers, and other departments to promote early discharge planning, patient care, and performance improvement. It maintains knowledge of community resources and distributes or obtains resource materials as needed. The Case Manager follows organizational and departmental policies, quality, safety, and infection-control standards; protects confidentiality; maintains accurate documentation; and contributes to a safe environment and effective working relationships.

Requirements

Current Florida nurse licensure; RN preferred. Alternatively, a social worker with acute-care hospital experience.
Three to five years of experience in an acute-care hospital setting.
BLS.
Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance coverage.

Nice To Haves

One to two years of hospital case-management experience or related experience is preferred.
RN licensure is preferred.

Responsibilities

Perform preadmission, admission, continued-stay, and retrospective reviews and observation tracking.
Conduct reviews in a timely and orderly manner.
Apply working knowledge of InterQual level-of-care criteria and applicable Medicare, Medicaid, managed-care DRG, and private insurance requirements.
Refer inappropriate admissions, unnecessary continued days, and procedures that do not meet approved indications to the Case Manager Director for Physician Advisor review.
Participate in process improvement activities to improve utilization and compliance.
Assess Medicare, Medicaid, and high-risk patients to determine discharge-planning needs and document assessments.
Communicate with physicians about discharge-planning needs and assist with facilitating post-hospital care.
Maintain knowledge of community resources, distribute resource materials to patients when needed, and obtain other resources as needed.
Communicate with patients and families to assess discharge needs and involve them in the plan of care.
Document discharge planning on an ongoing basis.
Account for patients' financial status, diagnoses, and discharge needs.
Ensure home-care needs are met by discharge, with a goal of completing arrangements 24 hours before discharge when the discharge date is known.
Determine the assistance, setting, and resources needed by patients and families, and provide appropriate resources or facility lists.
Work with the Case Management team and other areas to promote early discharge planning.
Provide support with Advanced Directives.
Assist patients and families with the grieving process and refer to Pastoral Care as appropriate.
Identify when social-work referrals are needed and make referrals as appropriate.
Build and maintain relationships with providers and communicate successes and failures as appropriate.
Follow departmental and organizational policies, procedures, objectives, quality and safety standards, and infection-control standards.
Use the intranet to access policy and procedure documents.
Maintain confidentiality of patient, physician, and personnel information.
Help maintain a safe environment for patients, visitors, and staff and adhere to standard infection-control guidelines.
Maintain documentation that meets current standards and policies.
Maintain good working relationships within the department and with other departments; consult other departments as appropriate on patient care and performance improvement.
Follow the chain of command appropriately.