Nurse Case Manager, Per Diem

Job Summary

Provides case management services to a caseload of low- and medium-risk patients. Interviews patients and their caregivers to evaluate needs, goals, and current services. Determines initial eligibility, benefits, and education for all admissions, assessing medical necessity and required level of care to inform physicians. Reviews and enters authorization data. Develops a client-focused case management plan in collaboration with healthcare team, patient, and caregivers that is consistent with regulatory, accreditation, and regional guidelines. Assists patients with gaining access to care based on their needs, making referrals as appropriate. Coordinates resources and services to assure continuity and quality of care. Attends case management rounds with clinician and reviews authorizations and diagnoses as needed. Assesses patient progress toward treatment milestones and care plan goals. Identifies barriers to achieving goals and ensures that they are discussed with the patient and care team thoroughly. Verifies that all services remain consistent with established guidelines and standards. Documents the patients case in all medical files. Reviews benefits/services available to patients, caregivers, and other members of the community and assists with problem solving identified concerns. Identifies patients ready for disposition planning activities. Develops and communicates a comprehensive disposition plan in collaboration with the patient, caregivers, physician, nurses, social services, and other healthcare providers and agencies. Obtains authorizations as needed for patient services. Attends professional seminars, workshops, and approved educational programs and workshops. Monitors operational team data and key metrics applied to own work. Makes suggestions for change or improvement as needed. Ensures adherence to policies to meet regulatory requirements.

Essential Responsibilities

• vision; determining initial eligibility, benefits, and education for all admissions independently; reviewing and entering authorization data (e. g., authorization data regarding admitting/principle diagnoses, bed type(s), and disposition data for accuracy, after visit summary) and identifying and documenting inaccuracies; recommending research plans that identify new and/or existing options to assure that quality, cost-efficient care is provided; and leveraging comprehensive knowledge to assess medical necessity for hospital admission and required level of care to inform physician.
• vision.
• vision; providing case management to a caseload of low- and medium-risk patients referred to external facilities/agencies with minimal super
• vision; applying standard strategies and concepts to propose recommendations in interdisciplinary team meetings with internal and/or external stakeholders; and leveraging comprehensive knowledge of the patients case to act as a resource for physicians, health plan administrators, and contracted vendors.

Minimum Qualifications

Bachelors degree in Nursing or related field AND minimum three (3) years of experience in nursing, case management, or a directly related field.

Registered Professional Nurse License (Georgia) required at hire