Case Manager Utilization Nurse

Job Description

Under the direction of the Manager, Clinical Resource Management; the Case Manager is responsible for the activities of utilization management, case coordination and the development and implementation of a discharge plan for an assigned group of patients. The Case Manager serves as a resource for other members of the healthcare team and provides education to team members on issues related to the continuum of care, reimbursement, regulatory agency guidelines and resource use. Through collaboration, the Case Manager assures that the treatment plan is implemented accurately, in a cost effective and efficient manner in order to promote customer satisfaction and prevent delays in care and discharge.

Responsible for reviewing severity of illness and intensity of service indicators to assure that appropriateness of care criteria is met. Documents reviews and discharge planning in the medical record and/or the computer system as appropriate; Collects and maintains data for tracking and reporting for outcome studies and performance improvement.

Requirements

Minimum Bachelor’s degree in Nursing. Experience in working with mental health patients required. Knowledge of the local and State agencies required.Knowledge of CMS and JCAHO Standards required. Case management experience required. Licensed in the State of Alabama as a registered nurse. ICD-9 code book, DSM, computer, and software (including Affinity, Microsoft Word, Excel, and GroupWise), fax, copier and other Office equipment. Equipment used in the delivery of patient care. Computer skills, effective communication skills (verbal and written), time management and critical thinking skills. Working knowledge of healthcare reimbursement, counseling, community resources, continuum of care and team building. Works predominantly indoors with moderate amount of daily walking, standing and under high levels of stress. May be exposed to the risk of communicable diseases, radiation, chemicals and injury related to movement of patients and/or equipment involving a minimum of 50 pounds, or injury from irrational patients or persons. Manual dexterity necessary for typing, writing and manipulation of a mouse. Routine bending, stooping, squatting and overhead use of arms.