RN Care Manager

Job Details

Description

Position Summary:

Facilitates the timely coordination of quality health care services to meet patient specific healthcare needs in a cost-effective manner to promote positive outcomes. Includes utilization management, discharge planning, and quality monitoring. Ensures payers’ requirements for information, authorizations and certifications are met. Provides a communication link between all involved in the case management plan

Essential Duties And Responsibilities

• Identifies payer source and facilitates communication of information to assure authorization and reimbursement/funding of patient care.
• Ensures medical necessity and obtains authorization for continued care for patients, meets requirements and complies with contractual agreement, and assumes an active role in denial management.
• Provides communication link between all involved in case management plan, assures coordination of care in collaboration with Medical team, and facilitates transition to next phase of care by serving as liaison between settings.
• Identifies case management needs through review of record, participation in rounds, care conferences and clinician/family contact. Monitors patient/family progress in relationship to plan of care and expected outcomes.
• Participates in the documentation and use of interdisciplinary plan of care (IPOC), refers families to resources available to meet identified needs and advocates consideration of all options available to assure quality of care in the most cost-efficient manner.
• Initiates discharge plan at earliest time possible and meets with families in order to involve caregivers in discharge planning timelines/goals. Works closely with medical team in order to accomplish discharge goals and timeframes.
• Ensures referrals are made to appropriate services (WIC, Early Intervention, etc.) and coordinates associated activities. Ensures assessment of on-going care needs is documented.
• Collaborates with patient care teams to develop Best Practices. Tracks outcome performance data and identifies significant outcomes when indicated.
  
  

Qualifications

• Minimum of 1 -3 years of experience in Care Management
• Current IL RN Licensure
• Bachelor’s degree preferred