RN Case Manager (8A-4:30P)

• Able to perform preadmission, admission, continued stay, and retrospective reviews and observation tracking.
• Conducts reviews in a timely and orderly fashion.
• Has working knowledge of InterQual level of care criteria.
• Has working knowledge of Medicare, Medicaid, as well as Managed Care DRG assignment.
• Properly reviews private insurance as determined by pre-established contracts.
• Able to verify that all inappropriate admissions, unnecessary continued days, and procedures not meeting approved indications are given to the Case Manager Director for review by the Physician Advisor.
• Participates in process improvement activities aimed at improving utilization and compliance.

Performs assessments on Medicare, Medicaid and high-risk patients to determine discharge planning needs, always documents assessments.

Communicates with physician regarding discharge planning needs of the patient. Assists the physician to facilitate post-hospital care.

Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed. Is able to obtain other resources as needed.

• Initiates ongoing communication with the patient and patient’s family to assess discharge needs.
• Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.
• Documents discharge planning in an ongoing manner.
• Demonstrates knowledge of patients’ financial status, diagnosis and discharge needs.

Is responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known

Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.

Actively participates in discharge planning by working effectively with the Case Management team and other areas to promote early discharge planning.

• Provides support with Advanced Directives.
• Assists patient/family with the grieving process and makes referrals to Pastoral Care, as appropriate.
• Identifies need for referral to social worker and makes referrals as appropriate.

Build and maintain solid relationships with providers. Effectively communicating successes and failures with them as appropriate

Adheres to departmental policies, procedures, and objectives, and quality, safety, and infection control standards.

• Demonstrates competence in using the intranet to access policy and procedure documents
• Practices according to the policies and procedures outlined by the organization.
• Maintains and respects confidentiality of patient/physician/personnel information
• Participates actively in the maintenance of a safe environment for patients, visitors, and staff.

Adheres to Standard Infection Control Guidelines

• Documentation meets current standards and policies.
• Maintains a good working relationship both within the department and with other departments
• Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
• Follows chain of command appropriately.

Regulatory Requirements

Current nurse licensure in the state of Florida, RN preferred; or social worker with acute care hospital experience

Must have three to five years’ experience in an acute care hospital setting. Prefer at least one to two years hospital case management experience or related experience.

Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.+

BLS