Methodist Hospitals

RN CASE MANAGER-CASE MANAGEMENT

Posted 7 Days Ago

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Merrillville, IN, USA

In-Office

Mid level

Healthtech

The Role

Coordinates inpatient care from admission through discharge or transfer. Performs chart reviews to assess medical necessity, level of care, documentation, payer requirements, and continued-stay authorization. Assesses patients for discharge barriers, collaborates with healthcare teams and families, coordinates referrals and services, supports discharge planning, and contributes to quality improvement initiatives.

Summary Generated by Built In

OverviewCase Manager is responsible for chart review to evaluate medical necessity for admission, continued stay, and the appropriate level of care. Monitors the care of assigned patients to assure quality cost effective utilization of resources and optimal outcomes. Responsible for coordinating the patient's plan of care from admission to discharge and or transfer to another level of care. Responsibilities

PRINCIPAL DUTIES AND RESPONSIBILITIES (*Essential Functions)

Applies to individual case, through chart review, third payer regulations that govern admissions, continued stay, and discharge, i.e. IS/SI.

Collects data related to clinical improvement initiatives for the purpose of developing action plans.

Conducts concurrent chart reviews to assure complete and accurate medical records documentation.

Coordinates the patient's plan of care with all members of the health care team including the patient, caregiver, and or family members and case management.

Demonstrates proficiency in patient assessment and documentation.

Interviews and assesses patients to determine potential barriers to timely discharge/transfer to another level of care.

Provides all payers with accurate, updated information.

Obtains covered stay certification and prior authorization as appropriate.

Refers cases when appropriate to physician advisor for medical necessity, continued stay, physician education and appropriate level of care.

Refers to Social Services when appropriate.

Ensures discharge planning to the appropriate level of care, sub-acute, hospital units, and outpatient services.

Supports hospital CQI programs by participation on relevant teams.

Performs other duties as needed and/or assigned.

Qualifications

JOB SPECIFICATIONS (Minimum Requirements)KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of appropriate and timely return transition levels of care.
Knowledge of CARF, Regulatory Agencies and State Board of Health, Long Term Care, Acute Care and Ambulatory Care Standards.
Demonstrates excellent interpersonal and problem-solving skills.
Demonstrates self-directed, goal orientated and customer service.
Excellent organizational and prioritization skills to meet deadlines.
Capable of functioning effectively across service lines.
Ability to assess and interpret data about the patients status in order to identify each patients age, specific needs and provide the care needed by the infant, child, adolescent, young adult, middle adult and geriatric patient.
Ability to independently perform comprehensive chart review with subsequent abstraction or relevant information including interpretation of lab results, EKG and other medical tests.
Ability to communicate effectively both verbally and in writing.
Ability to provide compassionate patient care orientated with an effort for timeliness and accuracy in the delivery of service.
Ability to respond positively to the needs of patients and family. Addresses customer concerns in a private, respectful and calm manner.

EDUCATION

All post high school education must have been obtained from a recognized College or University.

Associates Nursing Required
Bachelors Nursing Preferred

EXPERIENCE

3 years Acute Care experience Required

LICENSE/CERTIFICATION

Active Licensed Registered Nurse
Basic Life Support Certification

STANDARDS OF BEHAVIORMeets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCEDemonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.

Skills Required

Associate degree in Nursing from a recognized college or university
Bachelor's degree in Nursing
Three years of acute care experience
Active Registered Nurse license
Basic Life Support certification
Ability to perform comprehensive chart reviews and interpret laboratory results, EKGs, and other medical tests
Knowledge of healthcare regulatory, acute care, long-term care, ambulatory care, and transition-of-care standards

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The Company

2,412 Employees

Year Founded: 1923

What We Do

Methodist Hospitals is a nonprofit healthcare organization serving Northwest Indiana. Its mission is to provide compassionate, quality health care to all those in need. The organization operates three campuses with 562 inpatient beds and employs 2,412 people, including 590 physicians and allied health professionals. It provides hospital and medical services while emphasizing patient care, physician practice, employee experience, and community health.