RN Case Manager performs a variety of tasks as coordinate’s plans of care for hospital and nursing home patients from admission to discharge to ensure that the continuation of care is provided promptly and effectively. Reports directly to Manager of Case Management in the Utilization Management Department.
DUTIES AND RESPONSIBILITIES:
- Communicate with hospital, attending physicians and PCP the daily tracking of all hospital and nursing home admissions and discharge for both statistical and cost management purpose.
- Communicates with on call physician to obtain after-hours reports of admissions, discharges and emergency room visits.
- Communicates with DMC managers on members discharged from inpatient facilities to assure appropriate medical care follow up
- Coordinates the transfers of patients as instructed by the Medical Director or PCP.
- Arrange direct admissions to hospitals and placement in nursing homes
- Assist PCP in placing patients at SNF
- Monitor length of stay (LOS) for both hospital and nursing home patients and make necessary discharge arrangements
- Verify membership eligibility prior to delivery of services
- Obtain weekly update in all nursing home patients
- Maintains daily logs of hospital admissions and discharges and nursing home placements
- Collects, prepare and maintain data utilized for quality and utilization management
- Enters admissions and concurrent review information in the system
- Communicates potential catastrophic and stop loss patients
- Enter information regarding patients related to possible subrogation and/or cost allocations
- Research inpatient admissions in all health plan sources
- Other duties as assigned
Planning and organizing, communication skills, attention to detail, adaptability, customer service orientation, problem solving, decision-making, confidentiality, integrity, stress tolerance.
EDUCATION AND EXPERIENCE:
- Valid Register Nurse license in the state of Florida.
- BSN preferred
- 2-5 years of relevant experience in the healthcare industry preferred
- Knowledge of terminology CPT codes and ICD 10
- Bilingual English/Spanish/Creole strongly preferred
- Excellent communications written, verbal, time management and organizational skills
- Knowledge of interqual and or MCG preferred
- Knowledge of applicable regulations and state and federal laws
- Computer skills including knowledge of relevant software
- Ability to multitask in a fast pace environment
Note: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, knowledge, and skills required for this position. Doctor’s Medical Center is an equal employment opportunity employer. Employment offer subject to qualifications, references, and background check.
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