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Case Manager Registered Nurse - FT Days - Victoria Southeast

Company: Post Acute Medical
Location: Victoria
Posted on: May 31, 2021

Job Description:

Case Manager

FT Days 


The Case Manager is responsible for the interdisciplinary coordination of care for a designated patient population. The Case Manager performs reviews of all inpatient admission records to ensure proper utilization of hospital resources and determination of admission for appropriate level of care. Assesses and identifies discharge needs and coordinates appropriate discharge plan. Works collaboratively with the interdisciplinary team to facilitate achievement of desired financial and quality outcomes. The Case Manager will also maintain and enhance payor relationships. Performs other related duties as assigned or requested. 

Admission Data Collection and Assessment

• Assesses, plans, monitors, and coordinates plan of care from pre-admission to community re-entry through the implementation of case management standards and processes.
• Assesses the individual’s personal and medical history, current status, diagnosis, prognosis, and the proposed treatment plan.
• Promotes and utilizes the appropriate level of care for the patient and refers to other facilities as needed.
• Adheres to contract agreements and specific criteria.
• Serves as a liaison with payor source points of contact to verify and guarantee coverage and identify items required to process the claim for service.
• Assists patient and or caregiver in developing realistic goals to direct the treatment regimen.
• Proactively communicates with payor source to explore coverage solutions (flex benefits, out of contract, etc.).


Planning, Implementation & Facilitation

• Promotes optimal outcomes for the patient within the boundaries of the diagnosis.
• Coordinates and facilitates interdisciplinary team (IDT) meetings and plan of treatment.
• Meets with patient, family, and IDT to facilitate “continuity of care”.
• Implements utilization review process and continuously evaluates the appropriate level of care with the interdisciplinary team and payor, and patient/caregiver(s). Proactively obtains authorization for any extension of service of LOS.
• Coordinates the discharge plan with the IDT and providers.
• Monitors expense versus revenue for caseload on a daily basis.



• Proactively collaborates with the health care team, payors, community agencies, providers and legal representatives to ensure continuity throughout the continuum.
• Serves as a liaison with the treatment team and the primary care physician, referring physician, medical director, patient/caregiver(s), and other parties as appropriate.
• Promotes effective communications among treatment team members, patient/caregiver(s), primary care physician, referring physician, medical director, and payor.
• Participates in care conferences, family conferences, etc. when indicated.
• Educates and supports the individual/family to be empowered and self-reliant in being advocates for themselves.
• Uses the mechanism of early referral to promote and provide optimum care and cost containment.
• Represents the individual’s best interests through assisting in finding necessary funding, offering treatment alternatives, and coordinating treatment.


Monitoring & Evaluation

• Continuously reviews and evaluates the patient’s progress, as reflected by the goals defined in the treatment plan.
• Uses appropriate auditing processes and tools to ensure department and treatment efficiency.
• Participates in performance improvement evaluation processes with particular emphasis on results-oriented treatment.


Professional Growth

• Maintains professional growth in case management by: attending continuing education opportunities; reviewing pertinent professional literature; maintaining knowledge of current community resources; and reviewing and being familiar with the managed care marketplace to determine managed care growth potential, opportunities, penetration, service trends, relationships, networks, etc.

Education and Training: RN licensure in the state where the hospital resides preferred. Current BLS certification required.


Experience: Three to five years of inpatient experience, preferably in an acute, IRF or LTACH setting.


Knowledge, Skills, and Abilities:

• Excellent clinical and assessment skills.
• Effective education/presentation skills.
• Excellent written and oral communication skills.
• Effective crisis management skills.
• Effective team leadership skills.
• Knowledge of payment/reimbursement systems.
• Knowledge of patient rights and commitment to patient advocacy.
• Ability to collect, document, and analyze data.
• Understanding of claims submission process.
• Word processing and data entry skills.
• Network access to community, state, and national resources and health services organizations.

Keywords: Post Acute Medical, Victoria , Case Manager Registered Nurse - FT Days - Victoria Southeast, Other , Victoria, Texas

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