RN CASE MANAGER Job at HealthTexas
Position Summary
The RN Case Manager actively participates in the assessment and coordination of patient care through discharge planning and oversight of the referral process. Interfaces directly with physicians, members and other providers to enhance cooperation and understanding regarding health care plan coverage and benefits. Works with patients and families as they progress through the in-patient process from admission to discharge.
Responsibilities
- Present at two weekly case management meetings patient updates.
- Attend scheduled meeting.
- Demonstrates sound knowledge of computer documentation.
- Utilizes effective communication skills to develop relationships with patients, physicians and other health care providers.
- Confirms patient’s benefits and eligibility
- Create authorizations in the EZ Cap system for admissions.
- Provide an authorization number to the Hospital
- Notify Hospitalist of admissions.
- Physical and Social assessment of patient upon admission.
- Using Medicare, Health plan and MCG guidelines to determine medical necessity.
- Document assessment and criteria in EZ Cap.
- Begin discharge planning, coordination of services and follow up care at the time of admission.
- Initiate a Care Plan upon patient’s admission to the hospital. Include the patient and their family to ensure they are receiving prearranged services after discharge.
- Evaluating patient’s progress periodically and make adjustments as needed to improve outcomes and address discharge needs or obstacles.
- Notify the Hospitalists or Medical Directors of changes in a patient’s condition.
- Arrange and provide authorization for next level of care, DME, Home Health upon discharge.
- Complete assignments for the case managers
- Monthly reporting of bed days
- Familiar with NOMNCs, DENC’s and IDN’s.
- Follow Medicare guidelines
- Address denials or appeals in a timely manner
Education and Experience
- Graduate of an accredited school of nursing, BSN preferred.
- Current Texas RN licensure required.
- Case Management Certification preferred.
- 3 years of clinical experience with strong interpersonal and organization skills.
- 3 years Prior Case Management experience preferred.
- Managed Care experience a plus.
Working Conditions/Physical Requirements
- Position duties require prolonged sitting, some bending, stooping and stretching.
- Occasional lifts and carries items up to 50 pounds.
- Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
- Involves frequent contact with staff, providers, patients and the public.
- Requires working in a multi-tasking environment and under stressful conditions where constructive criticism from others is encouraged.
We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
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