RN Case Manager
Job Code: 00035-34587
Days (rotating weekends)
1. Review health records for appropriateness of application of 2 Midnight Rule for initial review of all Medicare admissions. Perform continued stay reviews of trauma patients for appropriateness based on InterQual criteria.
2. *Performs admission and concurrent reviews for all payors and maintains legible documentation as directed by the Utilization Management Plan.
3. *Review of patient notes identifying and addressing any conflict in medical orders or lack of management plan.
4. *Build a rapport by providing continuity of care with patients and acting as their advocate throughout their hospital stay.
5. *Collaborate between multiple care givers and foster communication between medical teams and nursing staff
6. *Identifies and intervenes to coordinate care of trauma patients in relation to appropriateness of level of care, length of stay and resource utilization issues.
7. *Identifying barriers to discharge and contacting relevant personnel to overcome these.
8. *Initiates and monitors referral process of patients post discharge.
9. *Identifies, tracks, and records Avoidable Days [AD], intervening to prevent or decrease as appropriate.
10. *Initiates denial and appeal process in accordance with policy.
11. *Demonstrates awareness of current trends that influence health care practice and assures compliance with professional, regulatory, governmental and organization standards.
Required: Five + years of recent clinical experience.
Preferred: Commercial Utilization Management and/or Case Management experience; Case Management Experience.
Required: Registered Nurse
Last Edited: 08/09/2016