Case Manager - RN (PRN)

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 specific 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. Responsibilities: Evaluation and Analysis: Contributes to cost effectiveness and demonstrates awareness of benefit systems and cost-benefit analysis. Aims to maximize financial outcomes of the patient load using the continuum of care philosophy. Assists in developing, monitoring, and analyzing annual financial goals for the targeted population. Understands the capabilities of outside referral sources such as home health, sub-acute care, and skilled nursing facilities. Familiar with healthcare delivery systems and payor requirements for prior approval for admissions, procedures, and continued stays. Meets with treatment teams to provide utilization review information, discusses issues related to continued stay, discharge, and aftercare plans, evaluates current financial resources, and reviews documentation for appropriateness of continued stay and level of care. Partnership and Collaboration: Performs effective utilization review techniques working with physicians, third-party payors, and agencies to prevent payment denials or unnecessary days. Acts as a resource for unit personnel in resolving utilization/case management problems, communicating issues promptly to improve departmental efficiency. Collaborates with health team members to ensure reimbursement, discharge planning, and cost-effective, quality care. Plays a key role in discharge planning, assessing patient referral needs, and tracking avoidable days. Clinical Assessment and Quality: Assesses individuals' physical and mental impairments, develops treatment and discharge plans with the healthcare team. Evaluates medical necessity of admissions, facilitates appropriate care levels, and coordinates denials and appeals. Accesses community resources and understands federal legislation affecting individuals with disabilities, establishing support systems as needed. Standards and Professional Development: Adheres to departmental and hospital policies, safety, quality assurance, and infection control standards. Maintains current knowledge through seminars, workshops, conferences, and professional memberships. Other Duties: Performs additional duties as assigned or requested. Qualifications

Experience: Three years in general or specialty nursing practice Education: Associate's Degree Licensure: Current and unrestricted Louisiana State RN License Job Identification 40099 Job Category: Clinical Support Job Function: Case Management/Social Services Worker Type: Employee Regular or Temporary: Regular Requisition Schedule: PRN (As Needed) Hours: 8:00 am - 4:30 pm as needed Company: Our Lady of the Lake Hospital Inc

#J-18808-Ljbffr