Case Manager - Registered Nurse - FT Days - St. Luke\u0027s Rehab
Company: Post Acute Medical
Posted on: January 8, 2022
Case ManagerThe Case Manager is responsible for the
interdisciplinary coordination of care for a designated patient
population. The Case Manager performs reviews of all inpatient
admission records to ensure proper utilization of hospital
resources and determination of admission for appropriate level of
care. Assesses and identifies discharge needs and coordinates
appropriate discharge plan. Works collaboratively with the
interdisciplinary team to facilitate achievement of desired
financial and quality outcomes. The Case Manager will also maintain
and enhance payor relationships. Performs other related duties as
assigned or requested. - -RESPONSIBILITIESAdmission Data Collection
- Assesses, plans, monitors, and coordinates plan of care from
pre-admission to community re-entry through the implementation of
case management standards and processes.
- Assesses the individual's personal and medical history, current
status, diagnosis, prognosis, and the proposed treatment plan.
- Promotes and utilizes the appropriate level of care for the
patient and refers to other facilities as needed.
- Adheres to contract agreements and specific criteria.
- Serves as a liaison with payor source points of contact to
verify and guarantee coverage and identify items required to
process the claim for service.
- Assists patient and or caregiver in developing realistic goals
to direct the treatment regimen.
- Proactively communicates with payor source to explore coverage
solutions (flex benefits, out of contract, etc.).Planning,
Implementation & Facilitation
- Promotes optimal outcomes for the patient within the boundaries
of the diagnosis.
- Coordinates and facilitates interdisciplinary team (IDT)
meetings and plan of treatment.
- Meets with patient, family, and IDT to facilitate "continuity
- Implements utilization review process and continuously
evaluates the appropriate level of care with the interdisciplinary
team and payor, and patient/caregiver(s). Proactively obtains
authorization for any extension of service of LOS.
- Coordinates the discharge plan with the IDT and providers.
- Monitors expense versus revenue for caseload on a daily
- Proactively collaborates with the health care team, payors,
community agencies, providers and legal representatives to ensure
continuity throughout the continuum.
- Serves as a liaison with the treatment team and the primary
care physician, referring physician, medical director,
patient/caregiver(s), and other parties as appropriate.
- Promotes effective communications among treatment team members,
patient/caregiver(s), primary care physician, referring physician,
medical director, and payor.
- Participates in care conferences, family conferences, etc. when
- Educates and supports the individual/family to be empowered and
self-reliant in being advocates for themselves.
- Uses the mechanism of early referral to promote and provide
optimum care and cost containment.
- Represents the individual's best interests through assisting in
finding necessary funding, offering treatment alternatives, and
coordinating treatment.Monitoring & Evaluation
- Continuously reviews and evaluates the patient's progress, as
reflected by the goals defined in the treatment plan.
- Uses appropriate auditing processes and tools to ensure
department and treatment efficiency.
- Participates in performance improvement evaluation processes
with particular emphasis on results-oriented treatment.Professional
GrowthMaintains professional growth in case management by:
attending continuing education opportunities; reviewing pertinent
professional literature; maintaining knowledge of current community
resources; and reviewing and being familiar with the managed care
marketplace to determine managed care growth potential,
opportunities, penetration, service trends, relationships,
networks, etc.QUALIFICATIONSEducation and Training: RN licensure in
the state where the hospital resides preferred. Current BLS
certification required.Experience: Three to five years of inpatient
experience, preferably in an acute, IRF or LTACH setting.Knowledge,
Skills, and Abilities:
- Excellent clinical and assessment skills.
- Effective education/presentation skills.
- Excellent written and oral communication skills.
- Effective crisis management skills.
- Effective team leadership skills.
- Knowledge of payment/reimbursement systems.
- Knowledge of patient rights and commitment to patient
- Ability to collect, document, and analyze data.
- Understanding of claims submission process.
- Word processing and data entry skills.
- Network access to community, state, and national resources and
health services organizations. -ABOUT USPAM Health -is committed to
being the most trusted source for post-acute services in every
community it serves by utilizing experienced and dedicated staff to
provide high quality patient care and customer service. With over
44 Long Term Acute Care and Rehabilitation hospitals and 16
Outpatient Clinics currently in operation across the country, we
are proud to offer services including comprehensive wound care,
aquatic therapy, ventilator weaning, amputation treatment, pain
management and much more.Joining our PAMily allows you to work in a
collaborative environment with colleagues and leadership with
exposure to a variety of patient care levels. Aside from our
competitive pay, generous paid benefit time, and excellent
insurance options, you will also have opportunities for
professional growth through our Education Advancement Program.We
are excited to learn more about you and hope that you consider
joining us on a shared mission to improve the lives of others by
being an integral part of our We Care Program. Please take a moment
to visit us online at - for a comprehensive look at how we're able
to positively impact our local communities.PAM Health does not
discriminate and does not permit discrimination, including, without
limitation, bullying, abuse or harassment, on the basis of actual
or perceived race, color, religion, national origin, ancestry, age,
gender, physical or mental disability, sexual orientation, gender
identity or expression or HIV status, or based on association with
another person on account of that person's actual or perceived
race, color, religion, national origin, ancestry, age, gender,
physical or mental disability, sexual orientation, gender identity
or expression or HIV status.
Keywords: Post Acute Medical, Chesterfield , Case Manager - Registered Nurse - FT Days - St. Luke\u0027s Rehab, Healthcare , Chesterfield, Missouri
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