Registered Nurse Case Manager- Lavonia, GA

Location: Lavonia

Employment Type:

Full time

Shift:

Description:

The RN Case Manager (RN CM), works in collaboration with a multidisciplinary team by identifying and initiating discharge planning to accomplish the timely transition of patients to a post-acute hospital setting and to ensure patients progress along the continuum of care. RN CM facilitates patient transitions efficiently and in a cost-effective manner that ensures quality outcomes. RN CM utilizes established guidelines to support appropriate level of care throughout hospitalization in compliance with CMS and organizational utilization management requirements.

RN CM helps to ensure medical necessity is met by regularly reviewing severity of illness and intensity of service for patients to ensure appropriate and timely utilization of hospital services.

severity of illness and intensity of service for patients to ensure appropriate and timely utilization of hospital services.

Essential Functions and Responsibilities

Uses approved criteria for admission and continued stay reviews to ensure appropriate setting and timely implementation of plan of care. Collaborates with admitting and/or attending physicians regarding appropriate level of care/status determination. Consults with Physician Advisor and administrative leadership as necessary for those patients not meeting medical necessary services for acute care. Effectively organizes and sets priorities on assignment caseload. Knowledgeable of Medicare, Medicaid and non-governmental payer regulations for patient care requirements.

Timely completion of initial and concurrent reviews, to include OBS management. Completes biopsychosocial assessment of patients to determine post-acute needs. Implements safe discharge/treatment plans in a timely manner to prevent avoidable inpatient stays. Explores options with patient/family and appropriately assists in the decision-making process. Communicates discharge planning activities with interdisciplinary team daily through the maintenance of concurrent documentation and/or verbal report.

Refers cases to home health, hospice, skilled nursing care facilities, DME companies, and other OP services and provides concurrent information as required. Assures response to and documentation of received referrals/consultation within 24 working hours. Is a patent advocate. Identifies community resources and maintains working relationships with referral agencies. Demonstrates service excellence by following HIPAA guidelines and meeting the Conditions of Participation set forth by the Center of Medicare and Medicaid Services (CMS).

Identifies, processes, and documents CC44 accounts appropriately. Serves as a resource to the healthcare team. Evaluates hospitalized patients to ensure they are receiving services in the most appropriate and cost-effective level of care in collaboration with attending physicians and Physician Advisors. Maintains good rapport and cooperative relationships. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participates in their resolution.

Demonstrates self-directed learning. Maintains the confidentiality of information acquired pertaining to patients, physicians, employees, and visitors to Trinity Health facilities. Discusses patient and hospital information only among appropriate personnel in appropriately private places. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

Behaves in accordance with the Mission, Vision, and Values of St. Mary's Health System. Attends team huddles and meetings when working; if unable to attend then review of notes/minutes from meetings is required. Staff are accountable for knowing content of discussions. Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health's Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior.

OTHER FUNCTIONS AND…