Case Mgr 9/13/2016
JOB DESCRIPTIONAPPLY Job Code: 00448-34539
LEMENTS AND ESSENTIAL FUNCTIONS*
* Applies the rules of Severity of Illness, Intensity of Service, and Discharge Screens/Indicators consistently in evaluating medical necessity.
* Performs admission and concurrent review for all payers and maintains legible documentation as directed by the Utilization Management Plan.
* Educates patients and families to the patient s needs post discharge and informs them of the alternatives available to meet those needs.
* Refers patients who require extended care post discharge to long term care facilities. Once an appropriate bed is located, arranges for the patient s transfer
* Collaborates with community agencies to provide services to assist with housing, financial, transportation, psychosocial, educational, home health, and home medical equipment needs of patients/families post discharge.
* Initiates patient/family conference with the health care team to achieve positive outcomes.
* Identifies, tracks, and records Alternative Care Days (ACDs). Intervenes to prevent or decrease ACDs as appropriate.
* Initiates denial and appeal process in accordance with policy. Refers HINN letters to Director.
* Maintains knowledge base for identification and reporting of potential patients with contractual adjustment needs and length of stay issues.
* Provides crisis and supportive counseling to enhance the patient s and family s problem solving and coping skills. Counsels patient/families regarding advance medical directives.
* Takes a proactive role in discharge planning.
* Maintains knowledge base with an awareness of current trends that influence health care practice
* Required: Five + years of recent clinical experience as RN.
* Preferred: Commercial Utilization Management and/or Case Management experience; Quality Management Experience.
* Required: Registered Nurse with current Virginia licensure.
* Preferred: B.S.N.
Last Edited: 08/11/2016