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

Jackson County Hospital District•Marianna, FL

About The Position

The RN Case Manager conducts preadmission, admission, continued-stay, and retrospective reviews, as well as observation tracking. The role performs reviews in a timely and orderly manner and applies working knowledge of InterQual level-of-care criteria, Medicare, Medicaid, Managed Care DRG assignment, and private insurance contracts. The Case Manager identifies inappropriate admissions, unnecessary continued days, and procedures that do not meet approved indications, and refers them to the Case Manager Director for Physician Advisor review. The role also participates in utilization and compliance improvement activities. The Case Manager assesses Medicare, Medicaid, and high-risk patients to identify and document discharge-planning needs. In coordination with physicians, patients, families, the Case Management team, and other departments, the role helps arrange post-hospital care and needed home care, communicates about discharge needs, and documents planning on an ongoing basis. It identifies appropriate assistance, settings, facilities, and community resources; supports patients and families with Advanced Directives and the grieving process; and makes referrals to social work or Pastoral Care when appropriate. The role builds and maintains relationships with providers, communicates successes and failures as appropriate, and follows organizational policies and procedures. It maintains confidentiality, supports a safe environment, follows infection-control standards, ensures documentation meets current standards, and collaborates with other departments on patient care and performance improvement.

Requirements

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

Nice To Haves

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

Responsibilities

Perform preadmission, admission, continued-stay, and retrospective reviews and observation tracking in a timely and orderly manner.
Apply working knowledge of InterQual level-of-care criteria, Medicare, Medicaid, Managed Care DRG assignment, and private insurance contracts when conducting reviews.
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 aimed at improving utilization and compliance.
Assess Medicare, Medicaid, and high-risk patients to determine discharge-planning needs, and document assessments.
Communicate discharge-planning needs with physicians and assist physicians in facilitating post-hospital care.
Maintain current knowledge of community resources, distribute resource materials to patients as needed, and obtain other resources when necessary.
Communicate with patients and families to assess discharge needs, involve them in the plan of care, and document discharge planning on an ongoing basis.
Account for patients’ financial status, diagnoses, and discharge needs when planning care.
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 appropriate assistance, settings, and resources for patients and families and provide relevant resources or facility lists.
Participate in discharge planning with the Case Management team and other departments to promote early planning and discharge.
Provide support with Advanced Directives and assist patients and families with the grieving process; refer to Pastoral Care or social work as appropriate.
Build and maintain relationships with providers and communicate successes and failures as appropriate.
Adhere to departmental and organizational policies, procedures, objectives, quality and safety standards, and infection-control guidelines.
Use the intranet to access policy and procedure documents, maintain confidentiality, and contribute to a safe environment for patients, visitors, and staff.
Maintain effective working relationships within the department and with other departments, consult other departments as appropriate, and follow the chain of command.