RN Case Manager Apply
Hello,
My name is Max, and I am a Technical Recruiter at InfiCare I am reaching out to you for job opportunity with one of our clients.
Job Title: RN Case Manager
Location: Concord, MA 01742
Duration: 13 Weeks
Monday-Friday - 8:00am-4:30pm Required to work holidays Weekends as needed
If you are interested, please share your updated resume or you can call me at (703)-652-5191
Job Summary
- Ensures that care provided by the healthcare team is given in an efficient and cost-effective manner while promoting optimal patient outcomes.
- Assists the physician and healthcare team in promoting cost-effective utilization of healthcare resources.
- Ensures that the patient is admitted to the appropriate level of care and that care is provided in a timely manner utilizing standardized criteria and ensuring that federal and state regulations are followed.
- Collaborates with the patient, caregiver and healthcare team to assess the discharge needs of the patient and formulates/facilitates a safe and appropriate discharge plan.
Utilization Review:
- Reviews appropriateness of the admission and continued stay to ensure patients meet level of care for admission (observation or inpatient) and for continued stay in the hospital setting according to criteria (InterQual).
- Assesses patient's clinical course to verify patient's continued need for acute hospital level of care.
- Provides third party payers with concurrent review information as needed to comply with payers' requirements for documentation of medical necessity and negotiates resolution of any disagreement over the need for services.
- Monitors the utilization of observation services. Ensures that all testing is done in a timely manner for observation status patients thus preventing hourly delays and facilitates discharge in a timely manner or admission to inpatient status.
- Intervenes with appropriate individuals/departments regarding delays in service that may have an impact on quality of patient care and/or length of stay.
- Explores strategies to reduce length of stay and resource consumption with optimal patient outcomes.
- Promotes optimal reimbursement e.g. interface with finance, coding, participates in appeals to concurrent denials etc.
- Provides clinical information to third party payers to certify the need for post discharge services and negotiates coverage for appropriate post discharge services.
- Reviews daily report on working DRGs and GMLOS to use as a guideline for daily rounds and anticipated LOS on white board in patient rooms.
Discharge Planning:
- Ensures coordinated, timely, and seamless discharge planning by working with the interdisciplinary team and patient/family to coordinate needed services to ensure efficient continuity of care.
- Meets with patients/caregivers on caseload on admission to assess home situation, current needs and early identification of discharge planning needs. Facilitates discharge plan in collaboration with the interdisciplinary team.
- Reviews discharge plan daily for additional needs/changes. Forms a preliminary plan and a back up discharge plan when necessary and ensures plans are in place twenty four hours prior to discharge in collaboration with the interdisciplinary team.
- Advocates for patient and ensures that the patient and caregiver are included, understand, and accepting of the discharge plan.
- Communicates discharge plan and patient needs with the next provider of care which may include PCP, care coordination, SNF, acute rehab, home care, etc. to ensure seamless continuity of care for the patient.
Patient Care Coordination:
- Collaborates and participates with the primary nurse, social worker, and the interdisciplinary team in the ongoing clinical assessment of patient status and care management .
- Meets with patients who are readmitted to understand the reason for readmission from the patient and caregiver.
- Monitors patient's progress to ensure care is appropriate and timely.
- Assists the Healthcare Team in the coordination of care on the unit by serving as a resource to staff in a day to day clinically based problem resolution.
- Actively participates in daily patient care rounds.
- Assists in the coordination and facilitation of family meetings.
Outcomes Mangement:
- Records avoidable day data and others as appropriate and synthesizes the data to evaluate and recommend opportunities to improve the care process in order to decrease barriers to care and discharge thus decreasing length of stay and denial activity.
- Reviews department dashboard trends at least quarterly with nursing departments
Minimum Qualifications
- Education
- Graduate of professional accredited nursing school required
- BSN preferred
- Experience
- 3-5 years acute care or care management nursing experience required
- Licensure and/or Certification
- Current license as a registered nurse in Massachusetts required
- CCM preferred
(Max)
(703)-652-5191
