Position Details
Rn Case Manager Apply
Job Title: RN Case Manager
Facility: MercyOne North Iowa Medical Center
Address: 1000 4th St. SW, Mason City, IA, 50401
Contract: 12 weeks
Shift: 06:00 - 14:30
Pay Rate: $65/hr on W2
Facility: MercyOne North Iowa Medical Center
Address: 1000 4th St. SW, Mason City, IA, 50401
Contract: 12 weeks
Shift: 06:00 - 14:30
Pay Rate: $65/hr on W2
Department: Utilization Review (a sub-department of Acute Population Care Management)
EMR: Cerner PowerChart
EMR: Cerner PowerChart
Summary:
- The Utilization Review Case Manager responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services.
- Assists the organization in ensuring compliance with CMS rules and regulations and conditions of participation as well as commercial payer specific guidelines to prevent denials and revenue loss.
- Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines.
ESSENTIAL FUNCTIONS
A. Works directly with members of care team to effectively ensure appropriate acute utilization management
B. Interacts with outside review agencies and payors to inform them of extended stay plan and necessity of services for complex cases
C. Assures all appropriate clinical information is provided to outside agencies to secure authorizations
D. Reviews new admissions to ensure charts are analyzed for medical necessity and assures follow up of continued stays
E. Performs resource management for identified patients by confirming and coordinating benefits and resources appropriate for the patient and family including age appropriate considerations
F. Accurately and completely documents clinical reviews in accordance with documentation standards, policies, procedures and/or guidelines
G. Focused concurrent assessments on resource utilization and supportive documentation for the medical necessity of acute admissions 1. Screening: for benefits eligibility and communicate with patient and health care team when benefits and plan of care are out of alignment 2. Communication with payors regarding the anticipated services and disciplines needed by patient and families
H. Reviews all observation statuses to evaluate appropriate setting, admission or timely discharge.
I. Provides resource utilization consultation to physicians, nurses, therapist, and others regarding criteria for placement of a patient in an appropriate level of care within MercyOne North Iowa and Network to facilitate admission and continuity of care across the continuum
J. Assists nurses, physicians, therapists and social workers in ensuring MercyOne North Iowa is successful in resource utilization management strategies. K. Possesses case management skills to effectively manage all cases per established organizational standards
L. Discuss cases with Utilization Review Committee and/or third party entities when cases fail to meet admission, treatment, length of stay and/or discharge standards.
M. Maintains required department confidentiality and abides by HIPPA regulations.
