Case Manager - RN

Pratt Regional Medical Center • Pratt, KS, United States • $200k - $250k / year • 2w ago

Pratt, KS
Pratt Regional Medical Center
Social Services
Full Time
Days
Professional Technical
Req #: 2024105
Posted: October 17, 2024

Summary

Job Summary: Works with the interdisciplinary team with the objective of enhancing the quality of clinical outcomes and patient satisfaction while providing timely and accurate information for the hospital. The Nurse integrates the functions of utilization review, discharge planning, and resource management into a singular effort to ensure, based on patient assessment, care is provided in the most appropriate setting utilizing medically indicated resources. The hospital's utilization review plan and discharge planning procedures outline a collaborative practice to improve quality through coordination of care impacting length of stay, minimizing cost, and ensuring optimum outcomes. The Registered Nurse is responsible for team collaboration for continued compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning as Case Management.

Essential Duties and Responsibilities:

Promote the missions, vision, and values of the organization.
Adhere to Simply the Best Standard of Performance.
Attend and communicate during team meetings that foster interdepartmental collaboration as it pertains to utilization review and discharge planning.
Participate in multidisciplinary meetings and utilization review/case management meetings.
Provide input regarding utilization management and discharge planning processes.
Communicate with PRMC personnel regarding admissions and discharges to various units, patient status, or stay updates.
Assess discharge planning needs through communication with patients and their families.
Analyze insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
Review patients upon admission and refer cases to the facility utilization review committee when necessary.
Confer with medical and nursing personnel to determine the legitimacy of treatment and length of stay.
Abstract data from records and maintain statistics.
Assist with the discharge planning process alongside the Administrative Assistant for Case Management.
Actively participate in clinical documentation improvement activities.
Oversee the discharge planning process.
Work with direct supervisor to ensure targets are met for the annual plan.
Implement and review the Utilization Management Plan in coordination with the Utilization Review Committee.
Complete annual education requirements and maintain patient confidentiality.
Comply with regulatory requirements and organizational policies.
Attend regular staff meetings and in-services.
Other duties may be assigned.

Knowledge/Skills/Abilities: Knowledge of nursing services and insurance coverage preferred. Strong organizational and interpersonal skills. Ability to determine appropriate courses of action in complex situations. Ability to work independently, exercise creativity, and maintain attention to detail. Ability to manage multiple responsibilities and prioritize work. Maintain confidentiality of all medical, financial, and legal information. Complete work assignments accurately and promptly. Handle difficult situations involving patients, physicians, or others in a professional manner.

Education/Training: Associate degree (A.A.) or equivalent from a two-year college or technical school; Licensed as Registered Nurse; Preferred one year of related experience and/or training. BLS required.

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