RN Case Manager Position Available In Pulaski, Georgia

RN Case Manager 3.7 3.7 out of 5 stars 222 Perry Highway, Hawkinsville, GA 31036

General Statement of Functions:

A combination of social work and clinical, case management nursing requires organization and the ability to assess all possibilities in a patient’s situation.

Following the approved Utilization Review Plan, the Case Manager is responsible for care coordination of the integration of utilization management and discharge/transition planning functions to provide effective outcome based patient centered care.

Job Summary:

The Case Manager is a professional Registered Nurse and/or Licensed Practical Nurse with strong clinical knowledge and leadership skills who works under the supervision of the Nurse Manager and Chief Nursing Officer. Collaborates with the patients in all developmental stages, family, physician and interdisciplinary team and payer to plan, organize, coordinate and monitor the provision of cost-effective care in the most clinically appropriate setting, ensuring quality health care services and resources needed to promote optimal outcomes (clinical, functional, financial, satisfaction).

Essential Functions and Responsibilities:

1. Assesses the health status of patients including data from history and physical assessments, interview with patient/family to determine care needs related to the medical diagnosis, treatment options, financial resources, educational needs, psychosocial needs and discharge planning. 2. Utilizes clinical judgment, Millimans criteria and other established admission criteria to collaborate with the admitting physician, to assess patients for severity of illness and intensity of service in order to make recommendations regarding the most appropriate level of care for all patients. 3. Participates in multidisciplinary patient care rounds / conferences to review treatment goals, optimize resource utilization, and coordinate with patient/family on specific post hospital care needs and options and to address complex social issues and/or nonclinical barriers to discharge. 4. Educates physicians to insure compliance with the Utilization Management Plan for the hospital. 5. Refers cases not meeting defined level of care criteria to the admitting physician for review and intervention when necessary. Consults Physician Advisor when appropriate. 6. Works with third party payers to ensure coverage through authorization of stay in the time limitations established. 7. Appeals all denials for medical necessity and coordinates physician peer to peer requests and written physician appeals for all pay sources. 8. Monitor length of stay daily and assess to identify barriers to discharge using high risk assessment tool. 9. Participate in readmission management initiatives to decrease unnecessary readmissions. 10. Takes ownership for self-education and actively participates in department meetings, hospital and system wide committees, and quality and process improvement projects as requested. 11. Facilitates arrangement of post-acute services for all patients. 12. Play an active role as an advocate for the patient/family/caregivers 13. Coordinate appropriate reporting to legal agencies as needed with respect to abuse and neglect. 14. Follow Medicare guidelines regarding patient choice; admit/discharge notifications and appeals. 15. Identify, document and report quality, under and over use of resources, cost and risk variance related to patient’s plan of care. 16. Demonstrates strong communication skills that are effective in working with a variety of persons, including the patient, public, coworkers, guests, payers, outside agencies and medical staff. 17. Maintain a professional demeanor in all circumstances and professional relationships. 18. Actively promotes seeks to identify ways to improve patient centered care at Taylor Regional Hospital.

Qualifications:

Education:

Certification in Case Management preferred. Practical Nursing Diploma or Associate’s Degree in Nursing required. Bachelor’s Degree in Nursing preferred.

Required:

Current RN or LPN licensure by the Georgia State Board of Nursing or a Multi-state license recognized by the Georgia State Board of Nursing.

Training/Experience:

Strong clinical background in acute care.

Job Knowledge:

Thorough knowledge of care and/or utilization management and clinical nursing. Knowledge of Acute Level of Care Criteria and Federal guidelines outlining coverage of inpatient and outpatient hospital services, including observation is preferred. Knowledge of hospital audit and accreditation process by a hospital accreditation organization such as DNV. Current knowledge of third party payor requirements and applied clinical admission/discharge criteria (Milliman preferred). Must be a critical thinker and have the ability to work well under pressure and in high stress situations. Must possess culture sensitivity and diversification as well as effective time management skills in which to prioritize work and multitask. Must be assertive but also able to articulate and communicate in a calm and effective manner. Works well under minimal supervision.

Interrelationships:

Interacts with patients’ patients’ families, physicians, surveyors, auditors, co-workers, leadership, and staff from various departments in a professional manner. Communicates with insurance carriers and all post-acute resources.

Job Type:

Full-time Pay:

$30.00 – $40.00 per hour Expected hours: 40 per week

Benefits:

Dental insurance Health insurance Life insurance Paid time off Vision insurance

Schedule:

8 hour shift Monday to Friday No nights No weekends On call

Work Location:

In person