What are the responsibilities and job description for the Nurse (RN) Case Manager position at San Carlos Healthcare Corporation?
The Nurse (RN) Case Manager performs case management of assigned patients to ensure coordination of services in accordance with established treatment plan for timely and appropriate transition of patient based on care/service needs
ESSENTIAL FUNCTIONS (include, but not limited to the following)
- Manages and oversees care coordination of assigned patient case load to ensure delivery of all covered services identified for continuity of care across all levels of care and involved providers;
- Serves as primary contact/clinical liaison between referral hospitals, treatment facilities and patients/patient’s families to ensure delivery of effective and appropriate treatment in accordance with established plan of care
- Reviews charts of assigned patients to determine appropriate referral services based on assessed patient needs
- Facilitates, schedules and/or participates in a variety of patient care coordination activities to ensure patient and/or family personal and health care needs are met in a timely manner; proactively identifies alternative resources as needed
- Collaborates with patient, family members and other involved parties to ensure coordination of care coverage through private and governmental health care plans
- Performs utilization review of patient chart to ensure compliance with established criteria to maximize reimbursement/coverage of charges
- Receives and responds to all patient complaints; researches issues for corrective action as appropriate based on findings; escalates physician/provider issues to appropriate parties and identifies alternative solutions
- Collects, trends and analyzes outcome data to be used in identifying best practices and targeting performance improvement solutions
- Participates in departmental orientation, on the job training and quality assurance programs/initiatives
- Participates in a variety of department and hospital educational programs to maintain current skill and competency levels; identifies and discusses performance or training needs with Supervisor
- Perform other duties as assigned
