RN Case Manager - United Surgical Partners International

USPI Foundation Surgical Hospital of San Antoniois seeking a motivated Case Manager to join our team. We have 20 private suites and 5 OR rooms. We perform outpatient surgical procedures in Bariatric, Orthopedic, General, Neuro/Spine, ENT, Pain, Urology.

Job Summary: Facilitates progress through the continuum of care, from Pre-Admission through Discharge for Foundation Surgical Hospital; Provides feedback to payors on patient’s clinical status and secures approvals for additional days of stay; Monitors quality standards as determined by the Performance Improvement Plan and the Medical Staff Quality Indicators; Evaluates patients for discharge planning needs and appropriately directs the patient’s care; Monitors resource consumption for most effective use; Identifies teaching and psychosocial concerns for the best patient outcomes; assists in aggregating data for quality trending; assists in Infection Control surveillance; functions as a Patient Advocate to assist patients in resolving concerns.

Duties and Responsibilities

• Completes discharge planning assessment within 24 hours of admission
• Arrange/Coordinate all post-acute care services and equipment in timely manner to provide safe appropriate level of care and supplies upon discharge
• Compliance with CMS regulations for issuance of IMM, MOON, HINN, DND, ABN, Choice forms and all other discharge planning tasks as assigned
• Maintain HIPPA compliance
• Complete and or maintain working knowledge of daily Utilization Review tasks in accordance with hospital policy and Interqual guidelines to include prospective, admission, concurrent, retrospective reviews; correct admission status; avoidable days; medical necessity; continued stay criteria; LOS; Coding and DRG criteria; discharge readiness.
• Correspondence with interdisciplinary team, physicians, payers, and physician office staff to maintain cost effective and timely coordination of care throughout hospital stay
• Provide clinical documentation and requested information to payors in accordance with, but not limited to, appropriate admission status, clinical updates, admission/discharge notifications, post-acute care referrals and pre-authorization requests
• Timely documentation in EHR
• Serves as a departmental resource for auxiliary departments and staff
• All other duties as assigned

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Qualifications:

• Graduate of an accredited school of nursing, BSN preferred
• Current, active Texas RN licensure required
• BLS required
• Case Management certification preferred, but not required
• Minimum two (2) years acute care experience required
• Previous case management experience preferred
• Ability to work independently
• Working knowledge of Microsoft Word and Excel preferred;
• Willingness to learn computer applications necessary for work functions;
• Ability to adapt to changing situations and various personalities with a positive attitude.
• Ability to utilize Electronic Heath Care Record for patient documentation.
• Adheres to strictest confidentiality in dealing with patients, families, hospital personnel and the public

USPI complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce.If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date.If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.