The RN Case Manager in this position has overall responsibility for overseeing the clinical plan of care to conform to evidence-based practice and regulatory requirements. This position integrates care coordination, utilization management, and discharge planning.
RN Case Manager Responsibilities:
- Medical necessity screening
- Care coordination
- Discharge planning
- Facilitating multi-disciplinary patient care conferences
- Managing concurrent disputes
- Making the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST)
- Referring complex social issues to Social Service
- Communicating with patients and their families about the plan of care
- Collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy)
- Participating in weekly Complex Case Review
- Arranging for post-discharge patient education
- Clear, complete and concise documentation in eCCM
- Maintaining accuracy of patient demographic and insurance information
- Identifying and documenting potentially avoidable days
- Identifying and reporting over and underutilization
Qualifications:
Education: B.S.N. preferred, at least 5 years' bedside nursing experience required.
Certification/License: Current Professional Nurse License issued and/or recognized by Board of Nurse Examiners for the State of Texas; CCM or ACMA preferred.
Experience: Acute care Hospital Case Management Experience required; must have experience with InterQual criteria application; 5+ to 7 years experience.
Minimum Education: Bachelor's Degree.
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