Case Manager, RN

2 days ago Be among the first 25 applicants

Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health care facility to comply with government and insurance company reimbursement policies by performing the following duties personally or through subordinate supervisors.

• Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admission, treatment and length of stay of patients
• Review patient admission and approves admission or refers case to facility utilization review committee for review and course of action when case fails to meet admission standards
• Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay
• Determines eligibility, obtains pre‑certs and coordinates swing beds
• Obtains pre‑certs if needed
• Rounds daily with physicians and helps to develop a plan of care for the patient
• Performs pre‑certs for observation patients once the patient has been discharged
• Reviews demographic sheet for admission
• Checks payor source for social service potential referral
• Checks type of admission (ED or direct)
• Reviews diagnostic lab and imaging tests for abnormalities
• Checks for clinical pathway utilization
• Reviews admission H&P
• Reviews admission for interqual criteria
• Reviews and documents physician orders on worksheet
• Confirms appropriate diagnosis and comorbidity on worksheet

This job has no supervisory responsibilities.

Meets standards of behavior by using the ICARE moto;
Manages difficult or emotional customer situations;
Responds promptly to customer needs;
Solicits customer feedback to improve service;
Responds to requests for service and assistance;
Meets commitments.

Focuses on solving conflict, not blaming;
Maintains confidentiality;
Listens to others without interrupting;
Keeps emotions under control;
Remains open to others’ ideas and tries new things.

Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions.

Writes clearly and informatively.

Balances team and individual responsibilities;
Exhibits objectivity and openness to others’ views;
Gives and welcomes feedback;
Contributes to building a positive team spirit;
Puts success of team above own interests;
Able to build morale and group commitments to goals and objectives;
Supports everyone’s efforts to succeed.

Conserves organizational resources.

Shows respect and sensitivity for cultural differences; promotes a harassment‑free environment.

Treats people with respect;
Keeps commitments; inspires the trust of others;
Works with integrity and ethically;
Upholds organizational values.

Follows policies and procedures;
Supports organization’s goals and values.

Displays willingness to make decisions;
Exhibits sound and accurate judgment;
Includes appropriate people in decision‑making process;
Makes timely decisions.

Demonstrates persistence and overcomes obstacles;
Measures self against standard of excellence.

Prioritizes and plans work activities;
Uses time efficiently.

Approaches others in a tactful manner;
Reacts well under pressure;
Treats others with respect and consideration regardless of their status or position;
Accepts responsibility for own actions;
Follows through on commitments.

Demonstrates accuracy and thoroughness;
Looks for ways to improve and promote quality;
Applies feedback to improve performance;
Monitors own work to ensure quality.

Meets productivity standards;
Completes work in timely manner;
Strives to increase productivity;
Works quickly.

Observes safety and security procedures;
Reports potentially unsafe conditions;
Uses equipment and materials properly;
Compliance with all hospital and regulatory safety regulations and procedures.

Adapts to changes in…