RN Case Manager

Benefits : 401(k)

Health insurance

Paid time off

Vision insurance

Summary : Role has multiple components : clinical, leadership, and educational. Major areas of accountability include utilization management, care co-ordination, discharge planning, and quality management. Goal is optimal patient care at appropriate level, in financially expedient and efficient manner. Inherent in this process is monitoring and tracking / trending of data. The Case Manager is responsible for monitoring of clinical documentation with guidance to physicians and extenders as needed. Compliance with all hospital COP’s

Utilization Management

Insures care delivered in fiscally responsible manner

Reviews inpatient, observation cases using nationally accepted criteria for appropriate level of care, discharge and continued stay

Reports exceptions, variances to Utilization Review Committee and / or responsible staff

Makes informed recommendations as to Level of Care, Length of Stay,

Documentation for medical necessity

Insures payer requirements met to insure payment for services rendered. Appeals as needed. Monitor for trends, patterns and refers to Utilization Review Committee or appropriate staff

Compiles, integrates information as needed

Participates in Utilization Review Committee as member

Acts as liaison with payers, CMS, QIO as needed

Co-ordinates and educates hospital staff as needed

Maintains current and up to date knowledge of current Utilization strategies

Case Management / Care Co-Ordination

Strives for efficient care across the continuum

Reviews continued stays using nationally approved criteria

Tracks / trends information and reports to Utilization Review Committee and appropriate staff

Assess patient for discharge needs

Coordination of discharge needs with personnel for DME, HH, and follow up

Insures payer requirements met for reimbursement

Participates in educational programs such as Joint Camp as needed

Is available for physician education / interaction

Discharge Planning

Considers, addresses and coordinates needs outside of facility

Assesses patient on admission or within one business day for discharge needs

Coordinates, arranges services as needed

Complies with payer requirements to maximize reimbursement for post discharge services and minimize cost to patient

Complies with federal and state regulations concerning financial interest disclosure and choice of provider

Compiles statistics and monitor for trends. Report as required to Utilization Review Committee and or responsible party.

Quality

Continues to promote quality healthcare as a means to the goal of patient satisfaction

Practices continuous vigilance for potential quality issues in all areas of expertise and all assigned areas

Addresses concerns in a timely manner and appropriate fashion. Compiles information and statistics.

Reports tracking and trending results to appropriate committee and department heads

Continues to maintain current information to facilitate recognition of quality issue

Maintains up to date information bank

Education and Experience

Degree or Formal Training : Associate or Bachelor's Degree in Nursing

License, Certificate or Registration : Current LA State Licensure

Additional Information :

BLS Required

Seven paid holidays

Sick and vacation after waiting period

Health, vision, and dental coverage

Employer paid life insurance and long-term disability

401k with employer contribution

Pay in Lieu of Benefits option offered

Specialists Hospital Shreveport is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.