This position is for an RN – Case Manager I – Coordinated Care with a company in Jackson, MS.
Duties and Responsibilities: Case Manager I is accountable for designated patient case load and plans effectively in order to meet patient needs, manage the length of stay (LOS), and promote efficient utilization of resources. Coordinates/ facilitates patient care progression through the continuum. Works collaboratively and maintains active communications with physicians, nursing, and other members of the inter-disciplinary care team to effect timely, appropriate patient management. Addresses/ resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge. Utilizes conflict resolution skills as necessary to ensure timely resolution of issues. Collaborates with physicians and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost Effective; facilitates the following on a timely basis: completion and reporting diagnostic testing; completion of treatment plan and discharge plan; modification of plan of care, as necessary, to meet the ongoing needs of the patient; communication to third party payors and other relevant information to the care team; assignment of appropriate levels of care; completion of all required documentation in epic screens and patient records. Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Completes utilization management and quality screening for assigned patients. Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards. Identifies at-risk populations using approved screening tool and follows established reporting procedures. Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas. Refers cases and issues to care management physician advisor in compliance with department procedures and follows up as indicated. Communicates with third party payers to facilitate covered day reimbursement certification for assigned patients. Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed. Uses quality screens to identify potential issues and forwards information to clinical quality review department. Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care. Manages all aspects of discharge planning for assigned patients. Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician. Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation. Ensures / maintains plan consensus from patient/ family, physician and payor. Refers appropriate cases for social work intervention based on department criteria. Collaborates/ communicates with external case managers. Initiates and facilitates referrals through discharge for home health care, hospice, medical equipment and supplies. Documents relevant discharge planning information in the medical record according to department standards. Facilitates transfer to other facilities as appropriate. Actively participates in clinical performance improvement activities. Assists in the collection and reporting of financial indicators including case mix, los, cost per case, excess days, resource utilization, readmission rates, denials and appeals. Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction. Collects, analyzes and addresses variances from the plan of care path with physician and/or other members of the healthcare team. Uses concurrent variance data to drive practice changes and positively impact outcomes. Collects delay and other data for specific performance and /or outcome indicators as determined by administrator - resource management. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning, care transitions and care coordination). Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently. Ensures safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice. Promotes individual professional growth and development by meeting requirements for mandatory / continuing education, skills competency, supports department- based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff. The duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.
Education & Experience” Associate's degree in nursing with (4) years RN experience. Utilization management or previous case management experience a plus. Accredited case manager certification (ACM) or certified case manager (CCM) is a plus. Certifications, Licenses or Registration required: Valid RN license. Knowledge, Skills & Abilities Excellent interpersonal communication and negotiation skills. Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement. Understanding of pre-acute and post-acute venues of care and post-acute community resources. Ability to work independently and exercise sound judgement in interactions with physicians, payors, and patients and their families. Demonstrates commitment to the organizations mission and the behavioral expectations in all interactions and in performing all job duties. Performs duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency, and commitment to continuous quality improvement (CQI) process.
This business is an EOE/AA/Minorities/Females/Vet/Disability/Sexual Orientation/Gender Identity/Title VI/Title VII/Title IX/504/ADA/ADEA employer.