Registered Nurse Case Manager (Utilization Review) (RN) 9/13/2016
San Antonio, TX
JOB DESCRIPTIONAPPLY Job Code: 26109-69813
Days (rotating weekends)
Methodist Texsan Hospital, a campus of Methodist Hospital, excels in nearly all aspects of advanced cardiovascular services and is equipped with dedicated operating room suites and five functional heart catheterization labs. Orthopedic services, which include the famed Joint Replacement Academy, boast some of the best clinical results in the industry. Methodist Texsan Hospital s 30-bed inpatient rehabilitation unit is the newest in the community and takes a team approach to providing excellent rehabilitative care for its patients. The emergency room is full-service and its board-certified emergency medicine doctors work hard for the right clinical diagnosis who strive to take care of patients quickly and efficiently.
The RN Case Manager will work with patient/families identified to have discharge planning, psychosocial, financial, or other needs to develop a plan. The developed plan will: 1) Optimize functional and self-care abilities; 2) facilitate system access and appropriate utilization of services; 3) facilitate communication and coordination of efforts among health care team members; and 4) promote quality, cost effective outcomes. The Case Manager will demonstrate knowledge and skills necessary to develop a plan based on physical, psychosocial, educational, and age related criteria.
ESSENTIAL JOB FUNCTIONS:
1. Assesses discharge needs of all high-risk patients (and others referred). Identifies resources available to address the needs identified, coordinate referrals, and document plan.
2. Utilize community resources to support patient s post hospital needs. Documents choice in available resources.
3. Performs admission and continued stay reviews. Provides clinical information to payers upon request for certification and reimbursement of care. The RN Case Manager discusses alternate levels of care with physician. Refers cases not meeting acute care criteria to Physician Advisor as needed.
4. Facilitates and provides education of hospital staff, physicians, patients, and caregivers for purposes of efficient resource utilization
5. The RN Case Manager is knowledgeable of all JCAHO, HCFA, and state/federal requirements for provision of care, planning, and documenting.
6. Tracks resource statistics to identify improvement opportunities. Reports findings at medical staff and other hospital committee meetings.
EDUCATION REQUIRED AND/OR PREFERRED:
* 1. Graduate of an accredited diploma, associates, or baccalaureate degree nursing program. (required)
* 1. Current Texas licensure as a Registered Nurse (required)
* 2. Bachelor of Science in Nursing (preferred)
* 1. Minimum of 3 years clinical experience in area in which Case Management was performed. (preferred)
* 2. At least one year experience in utilization review, resource management, discharge planning, or case management. (preferred)
Last Edited: 06/14/2016