Registered Nurse (RN) Case Manager (PRN)
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POST DATE 9/13/2016
END DATE 11/15/2016
JOB DESCRIPTIONAPPLY Job Code: 00009-69978
Saturday's will be included with this PRN shift.
Responsible for facilitating the progression of the patient through the continuum of care. This facilitation includes evaluation of the history and physical, treatment plan, admission orders, and patient demographics against Inter-Qual and unit specific Admission/Discharge for the identification of the appropriate status and location for patient care. The Case Manager works closely with physicians and all clinical departments in assuring high quality, cost effective patient care.
All employees will be held accountable for attending training regarding the Code of Conduct program at least annually.
Appropriately utilizes all resources and available sources of information.
Assists with departmental data collection as assigned, and reports all statistical information in a timely manner.
Communicates with outside review agencies as necessary, and maintains appropriate professional contacts and liaisons.
Documents medical necessity review for established level of care in the utilization review module.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Evaluates assigned population of patients for risks and potential needs. All patients will be assessed within 24 hours of admission, or the next business day.
Establishes and coordinates plans for those patients with identified needs.
Ethics and Compliance Expectations 1. All employees will be held accountable for behaviors displayed relative to the values articulated in the Mission and Values Statement. Will act with absolute honest, integrity and fairness in the way we conduct our business and the way we live our lives.
Maintains current knowledge of regulatory rules and guidelines, as well as guidelines for contracted insurances. Remains knowledgeable regarding all applicable standards, guidelines, limitations, and restrictions.
Monitors, evaluates, and documents care outcomes using InterQual guidelines.
Participates in committees or departmental activities as might be assigned.
Refers appropriate cases to management and social worker as needed.
License / Certifications / Requirements:
Requires current Registered Nursing Licensure with the State of Texas. Prefer Case Management Certification. (CCM) or equivalent case managment certification. BCLS certification required.
Requires Graduate of an approved Professional School (RN) of Nursing.
A minimum of one year of experience in discharge planning, case management, utilization review, or bed managment. Prefer experience with insurance certification knowledge, level of care and Admission/Discharge criteria and InterQual knowledge. Must have effective communication skills, both oral and written. Computer skills needed, plus, the ability to work with others within a team to ensure quality patient care. Strong problem solving and customer service skills.
Last Edited: 09/12/2016