Franciscan Missionaries of Our Lady Health System
Case Manager - RN PRN Premium
Franciscan Missionaries of Our Lady Health System, Baton Rouge, Louisiana, us, 70873
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Case Manager - RN PRN Premium
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Franciscan Missionaries of Our Lady Health System
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Job Description The Case Manager 1 directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager 1 specializes in the review of information pertaining specifically to the assigned areas. Relies on education, experience, professional training and judgment to accomplish responsibilities. A wide degree of creativity and latitude is expected. Works under minimal supervision. The role involves directing utilization review for patient charts and treatment plans, focusing on quality of care and treatment criteria in specific departments such as Case Management, Geriatrics, Mental & Behavioral Health, or Home Health. Responsibilities may vary depending on the specific area.
Responsibilities
Evaluation and Analysis:
Contribute to cost-effectiveness and demonstrate awareness of benefit systems and cost-benefit analysis. Maximize financial outcomes using the continuum of care philosophy. Assist in developing, monitoring, and analyzing annual financial goals for targeted populations.
Understand the capabilities of outside referral sources like home health, sub-acute care, and skilled nursing facilities. Know the requirements for prior approval by payors for admissions, procedures, and continued stay.
Meet with treatment teams to provide utilization review information, discuss issues regarding continued stay, discharge, and aftercare plans, evaluate current financial resources, and ensure documentation supports the need for continued care at the appropriate level.
Partnership and Collaboration:
Perform effective utilization review techniques with physicians, third-party payors, and agencies to prevent payment denials.
Act as a resource for unit personnel to resolve utilization/case management issues and communicate problems to improve departmental efficiency.
Collaborate with the healthcare team to optimize reimbursement, discharge planning, and ensure cost-effective, quality care. Assess patient needs for referrals or alternative care levels, and track avoidable days.
Quality:
Evaluate the quality of medical services, determine medical necessity for admissions, and facilitate appropriate patient care assignments with physicians.
Provide timely information to third-party payors to facilitate financial outcomes, including coordinating denials and appeals.
Utilize community resources effectively. Be knowledgeable of ADA and other legislation affecting individuals with disabilities, and establish client support systems.
Follow all departmental and hospital policies, safety standards, quality assurance, and infection control protocols.
Stay current with trends in the field through professional development activities.
Other Duties as Assigned
Qualifications
Experience: Three years in general or specialty nursing practice
Education: Associate's Degree
Licensure: Current and unrestricted Louisiana State License as RN
About Us The Franciscan Missionaries of Our Lady Health System is a leading health care innovator in Louisiana and Mississippi, committed to high-quality, safe patient care through advanced technology and research. Established over 100 years ago, we aim to transform healthcare through performance and excellence.
In the last fiscal year, we served thousands of patients, with significant hospital capacity and community support, emphasizing care for the most in need and partnering across communities to improve health outcomes.
Additional Details Position Level: Mid-Senior level
Employment Type: Full-time
Job Function: Healthcare Provider
Industry: Hospitals and Healthcare
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Case Manager - RN PRN Premium
role at
Franciscan Missionaries of Our Lady Health System
1 month ago Be among the first 25 applicants
Get AI-powered advice on this job and more exclusive features.
Job Description The Case Manager 1 directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager 1 specializes in the review of information pertaining specifically to the assigned areas. Relies on education, experience, professional training and judgment to accomplish responsibilities. A wide degree of creativity and latitude is expected. Works under minimal supervision. The role involves directing utilization review for patient charts and treatment plans, focusing on quality of care and treatment criteria in specific departments such as Case Management, Geriatrics, Mental & Behavioral Health, or Home Health. Responsibilities may vary depending on the specific area.
Responsibilities
Evaluation and Analysis:
Contribute to cost-effectiveness and demonstrate awareness of benefit systems and cost-benefit analysis. Maximize financial outcomes using the continuum of care philosophy. Assist in developing, monitoring, and analyzing annual financial goals for targeted populations.
Understand the capabilities of outside referral sources like home health, sub-acute care, and skilled nursing facilities. Know the requirements for prior approval by payors for admissions, procedures, and continued stay.
Meet with treatment teams to provide utilization review information, discuss issues regarding continued stay, discharge, and aftercare plans, evaluate current financial resources, and ensure documentation supports the need for continued care at the appropriate level.
Partnership and Collaboration:
Perform effective utilization review techniques with physicians, third-party payors, and agencies to prevent payment denials.
Act as a resource for unit personnel to resolve utilization/case management issues and communicate problems to improve departmental efficiency.
Collaborate with the healthcare team to optimize reimbursement, discharge planning, and ensure cost-effective, quality care. Assess patient needs for referrals or alternative care levels, and track avoidable days.
Quality:
Evaluate the quality of medical services, determine medical necessity for admissions, and facilitate appropriate patient care assignments with physicians.
Provide timely information to third-party payors to facilitate financial outcomes, including coordinating denials and appeals.
Utilize community resources effectively. Be knowledgeable of ADA and other legislation affecting individuals with disabilities, and establish client support systems.
Follow all departmental and hospital policies, safety standards, quality assurance, and infection control protocols.
Stay current with trends in the field through professional development activities.
Other Duties as Assigned
Qualifications
Experience: Three years in general or specialty nursing practice
Education: Associate's Degree
Licensure: Current and unrestricted Louisiana State License as RN
About Us The Franciscan Missionaries of Our Lady Health System is a leading health care innovator in Louisiana and Mississippi, committed to high-quality, safe patient care through advanced technology and research. Established over 100 years ago, we aim to transform healthcare through performance and excellence.
In the last fiscal year, we served thousands of patients, with significant hospital capacity and community support, emphasizing care for the most in need and partnering across communities to improve health outcomes.
Additional Details Position Level: Mid-Senior level
Employment Type: Full-time
Job Function: Healthcare Provider
Industry: Hospitals and Healthcare
#J-18808-Ljbffr