Registered Nurse - Case Manager - Talent Software Services, Inc.
Oakland, CA 94609
About the Job
Position Summary:
This position coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. This position oversees the management of acute patient populations across the care continuum with a focus to provide coordinated and integrated care to prevent unnecessary admissions or readmissions. Provides discharge planning coordination and Intervention for the high risk patient presenting to the Emergency Department. This position strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimized denials of payment among a patient population with complex health needs.
Primary Responsibilities/Accountabilities:
Patient Initial and Concurrent Screening.
• Reviews initial physician admission care plan. Gathers additional medical, psychosocial and financial information from the patient/family interview, medical record assessment, physicians and other health care providers. Determines moderate or high-risk level for readmission. Conducts a screening for ancillary supportive services.
• Functionally supervises and actively leads the health care team in developing comprehensive, cost-effective care coordination plans that meet the clinical needs of our patients. Performs cost benefit analysis of care options.
• Formulates a transition plan after reviewing available/appropriate care options and obtaining input from the patient/family and physician, health care team, payers and community based support services.
• Identifies and refers quality and risk management concerns to appropriate level for corrective action plans and trending.
• Directs and oversees the Assistants to interview patient/family and determine preferences for post -acute care services. Utilization Management.
• Completes initial Inter Qual review screening upon admission for all patients placed in a hospital bed and documents, either inpatient or Observation (OBS) status.
• Performs Inter Qual continued stay and discharge planning reviews.
• Reviews medical record daily to ensure patient continues to meet level of care (LOC) requirements and that chart documentation supports LOC determination and assignment
• Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services
• Monitors Length of Stay (LOS) and outliers requiring additional resources and/or focus and reports to management.
• Collaborates with financial counselor for delivery of inpatient stay denials.
• Assures delivery of Medicare Important Message within 48 hours of discharge and no less than 4 hours of actual discharge
• Actively participates in patient rounds following the standard work as developed and collaborates with interdisciplinary team to assure timely discharge.
• Maintains an average Utilization Review (UR) accuracy rate at or above the goal.
• Utilizes Inter Qual criteria for potential/actual admissions to determine appropriateness of the admission, appropriateness of the setting and appropriateness of the level of care.
• Follows policies and procedures for Physician Advisor referrals.
• Facilitates and expedites the discharge of patients from the Emergency Department (ED) to alternate care settings.
• Consistently documents in the Electronic Health Record (EHR) and other electronic software.
• Maintains current knowledge of medical facility and Joint Commission discharge requirements.
• Initiates timely communication with ED/admitting physician when medical necessity deficiencies are identified for level of care ordered.
• Identify avoidable admissions and escalate as appropriate.
Care Coordination/ Care Transitions.
• Performs initial screening on all hospitalized patients upon admission to identify case management needs.
• Performs, documents and communicates assessment findings to health care team.
• Screens 30-day readmissions; reviews previous hospital record confers with interdisciplinary team on discharge plan
• Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge
.• Addresses complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge.
• completion of treatment plan and transition plan
Certifications:
Preferred:
This position coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. This position oversees the management of acute patient populations across the care continuum with a focus to provide coordinated and integrated care to prevent unnecessary admissions or readmissions. Provides discharge planning coordination and Intervention for the high risk patient presenting to the Emergency Department. This position strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimized denials of payment among a patient population with complex health needs.
Primary Responsibilities/Accountabilities:
Patient Initial and Concurrent Screening.
• Reviews initial physician admission care plan. Gathers additional medical, psychosocial and financial information from the patient/family interview, medical record assessment, physicians and other health care providers. Determines moderate or high-risk level for readmission. Conducts a screening for ancillary supportive services.
• Functionally supervises and actively leads the health care team in developing comprehensive, cost-effective care coordination plans that meet the clinical needs of our patients. Performs cost benefit analysis of care options.
• Formulates a transition plan after reviewing available/appropriate care options and obtaining input from the patient/family and physician, health care team, payers and community based support services.
• Identifies and refers quality and risk management concerns to appropriate level for corrective action plans and trending.
• Directs and oversees the Assistants to interview patient/family and determine preferences for post -acute care services. Utilization Management.
• Completes initial Inter Qual review screening upon admission for all patients placed in a hospital bed and documents, either inpatient or Observation (OBS) status.
• Performs Inter Qual continued stay and discharge planning reviews.
• Reviews medical record daily to ensure patient continues to meet level of care (LOC) requirements and that chart documentation supports LOC determination and assignment
• Works with Physician Advisor and Attending Physicians to obtain necessary documentation to support current LOC, alters LOC as needed and expedites discharge planning for patients who no longer require hospital services
• Monitors Length of Stay (LOS) and outliers requiring additional resources and/or focus and reports to management.
• Collaborates with financial counselor for delivery of inpatient stay denials.
• Assures delivery of Medicare Important Message within 48 hours of discharge and no less than 4 hours of actual discharge
• Actively participates in patient rounds following the standard work as developed and collaborates with interdisciplinary team to assure timely discharge.
• Maintains an average Utilization Review (UR) accuracy rate at or above the goal.
• Utilizes Inter Qual criteria for potential/actual admissions to determine appropriateness of the admission, appropriateness of the setting and appropriateness of the level of care.
• Follows policies and procedures for Physician Advisor referrals.
• Facilitates and expedites the discharge of patients from the Emergency Department (ED) to alternate care settings.
• Consistently documents in the Electronic Health Record (EHR) and other electronic software.
• Maintains current knowledge of medical facility and Joint Commission discharge requirements.
• Initiates timely communication with ED/admitting physician when medical necessity deficiencies are identified for level of care ordered.
• Identify avoidable admissions and escalate as appropriate.
Care Coordination/ Care Transitions.
• Performs initial screening on all hospitalized patients upon admission to identify case management needs.
• Performs, documents and communicates assessment findings to health care team.
• Screens 30-day readmissions; reviews previous hospital record confers with interdisciplinary team on discharge plan
• Proactively identifies barriers to discharge and works with multi-disciplinary team to expedite care, monitor length of stay (LOS) and facilitate discharge
.• Addresses complex clinical and social situations efficiently in order to avoid unnecessary delays in discharge.
• completion of treatment plan and transition plan
Certifications:
- CA RN License
- BLS
- ACLS
Preferred:
- RN Case Manager with acute hospital discharge planning experience; inpatient acute rehabilitation preferred.
Source : Talent Software Services, Inc.