Facility: OrthoIndy Hospital MAIN, Indianapolis, IN
Department: OIH Case Management
Shift Details: XXXXXXX

At OrthoIndy everything we do is about creating a caring, connected and committed workforce that directly improves the quality of life for our employees and customers.

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At OrthoIndy, weprovide leading-edge bone, joint, spine and muscle care from 12 OrthoIndylocations throughout Central Indiana, staying true to our mission and ourpatients by offering a full range of procedures and treatment options. We have over 80 physicians in our practice andwe continue to be one of the most highly respected and trusted orthopedicpractices in the Midwest. OrthoIndy hasreceived national recognition for patient safety and orthopedic excellence andour philosophy is a physician-owned hospital model where patients experiencesuperior service, safety and patient satisfaction because physicians areinvolved in every aspect of your care. OrthoIndy is also the official orthopedicprovider for the Indiana Pacers, Indiana Fever and Andretti INDYCAR.

OrthoIndy Hospital Northwest, located in Indianapolis, Indiana,provides outpatient care and inpatient care, with 10 operating rooms, 2procedure rooms and a 42-bed inpatient unit for patients undergoing moreinvasive procedures, such as disc replacement, spinal fusion or total hip andknee joint replacement. Other services include an urgent care,clinics, pre-op clinic, imaging and physical therapy.

General Statement of Duties:

The Case Manager supports patients, families, and payer representatives, medical and allied health team personnel. The position aims to achieve optimal, timely, and durable patient outcomes, customer satisfaction, and management of resources and costs for the patient. The Case Manager serves as a patient advocate to ensure needs and communicated to the appropriate staff.

Essential Duties:

1. Makes contact with family or patient representative and performs introductory function and initiates discharge planning. Performs psychosocial assessment to determine pre-morbid history, human supports and available financial and community resources, cultural characteristics and interests, what the patient and family expectations for discharge.
2. In conjunction with the patient, family and treatment team arranges post hospital services such as home care or rehabilitation placement.
3. Promotes compliance with Medicare and payer source requirements. Responsible for contacting payer source to review accuracy of information, providing clinical update and discharge information as indicated by the payer source. Functions as liaison with payer representatives to manage financial resources, including verification of benefits for this and future settings Advocates with the payer on behalf of the patient to obtain needed services.
4. Documents payer source contact, including authorization, contacts, and days approved. Works in conjunction with admissions, billing, medical records, coding, and auditing to facilitate reimbursement.
5. Reviews medical documentation. Ensures completeness and accuracy of information, including appropriate admission orders.
6. Provides patient and family with overview of his/her rehabilitation program, and works in conjunction with the patient and treatment team to determine treatment goals and estimated length of time for completion.
7. Determines available financial resources and directs team planning to ensure conservation of funds and appropriate scope, intensity and duration of service delivery.
8. Works with the physician to determine and maintain appropriate patient status. Responsible for contacting the attending physician to request clarification of documentation or continued stay review questions. Responsible for informing Admissions and other departments of changes in patient status.
9. Reviews status, goals, and outcome barriers with the patient and treatment team and physician, monitors and facilitates progress towards goals. Ensures scope and intensity of services, financial coverage and alternative resources are appropriate to patient needs.
10. Reviews and monitors treatment plan and use of treatment resources, collaborates with treatment team and physician to determine cost effective means of obtaining an optimal patient outcome.

Requirements:

• Associate's Degree in Nursingrequired; Bachelor of Science in Nursing preferred from a nationallyaccredited nursing program
• 1-2 years clinical experience in an acute care hospital environment, surgical center, or rehabilitation setting required; 2-4 preferred
• Registered Nurse license required; Certified Case Manager preferred

OrthoIndy is an Equal Opportunity Employer