What are the responsibilities and job description for the Case Management Nurse position at Elite Medical Staffing?
Summary :
Hospital Contract, Case Manager role for 13-week Assignment 5x8 Day Shift, Monday - Friday. Our Partner Medical Center in Boston is looking for an experienced RN who can help coordinate care services at inpatient hospital. As a case manager, you’ll play a vital role in ensuring that each patient’s needs are met alongside a talented, interdisciplinary team of professionals. Elite Medical is committed to both patients and employees.
ESSENTIAL JOB FUNCTIONS
1. Coordinates and communicates a patient focused plan of care to ensure attention is being focused on progression towards discharge.
2. Monitors patient’s clinical course and communicates with the care team to collaboratively achieve patient outcomes.
3. Provides care plans to ensure a specific plan of care is in place to meet patient’s needs. 4. Provides alternative treatment options to ensure a cost effective and efficient plan of care.
5. Identifies and coordinates conferences to ensure patient / family needs are met.
6. Attains authorizations and pre-authorizations for, rehab transfers, test requirements, and procedures to ensure specified clinic and affiliated hospitals requirements are met for planned and unplanned admissions.
7. Applies criteria and processes to evaluate medical necessity and appropriate level of care.
8. Performs concurrent and retrospective record review to insure compliance to rules and regulations for patient classification, i.e., observation, ambulatory, and inpatient.
9. Reviews and responds to patient treatment plans in order to respond to non-certifications, appeal processes, and actual denials communicated through established systems.
10. Collaborates with Physicians and decision makers regarding prayer requirements, coverage limitations, benefits, and services to provide information for patient’s hospitalization and treatment options.
