RN Case Manager

Description

The RN-Case Manager monitors and manages patient care in relation to established levels of care criteria, length of stay,

regulatory agency and patient care guidelines to promote continuity of care, optimal patient outcomes, patient satisfaction, cost

efficiency and compliance.

Essential Functions:

To perform this job, an individual must perform each essential function satisfactorily with or without reasonable accommodation.

• Interacts professionally with patients/families; treats patients and their families with respect and dignity. Identifies and
  
  

addresses psychosocial, cultural, ethnic and religious/spiritual needs of patients and their families.

• Effectively and appropriately communicate with patients, physicians, family members and co-workers, demonstrating
  
  

customer service excellence through application of positive language principles, appropriate response and use of constructive

problem-solving techniques which foster positive outcomes.

• Reviews care and treatment for admission appropriateness against screening criteria
• Communicates with the various payer sources to ensure authorization of services provided and length of stay.
• Knowledgeable of the authorization process from the various payer sources and how it effects the revenue cycle.
• Performs follow-up reviews as requested by the various insurance carriers by any means necessary.
• Appropriately monitors Length of Stay.
• Communicates any change in continued stay approvals, denials or status level issues with Director & Team.
• Communicates pertinent financial information to the accounting group, as needed.
• Appropriate and accurate documentation of work where specified on a daily basis. Documentation meets current standards and
  
  

policies.

• Orders and arranges for home care equipment and/or healthcare needs based on the requests of Social Worker and/or Case
  
  

Manager.

• Works with third party payers to validate need for patient care and home care environment needs along with mindful of the
  
  

patients in network provider of services.

• Assumes responsibility for timely data collection for monthly reports needed by administration.
• Keeps current with principles and practices, regulations, and standards that apply to healthcare, to include the Medicare and
  
  

Medicaid Rules and Regulations and certification requirements of the various insurance carriers.

• Remains current on case management theory and practice, psychosocial issues current within the community and the
  
  

healthcare environment.

• Responsible for 48 hour post discharge phone calls and follow up.
• Assist with readmission reassessments.
• Functions as patient/family advocate and liaison between administration, patients, physicians, and other healthcare providers.
• Consults other departments as appropriate to collaborate in patient care and performance improvement activities.
• Assists in orientation and training of new staff/students as necessary.
• Performs other reasonably related job duties as assigned or requested, within scope of practice.
• The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified
  
  

and shall not be considered as a detailed description of all the work requirements that may be inherent in the position.*

Non-Essential Functions:

• Ensures supplies are adequately stocked and organized.
• Ensures equipment is operating safely and correctly.
• Responsible for minor housekeeping, maintaining department/facility cleanliness and safety, as needed.
  
  

Organizational Expectations:

Professional Conduct and Appearance:

• Adheres to dress code standards.
• Maintains a neat and clean appearance.
  
  

Interpersonal Skills and Confidentiality:

• Promotes harmonious relationships within and across departments.
• Safeguards confidential information related to patients, physicians, employees, and visitors.
  
  

Patient-Centric Environment:

• Creates a safe, comfortable, and therapeutic environment for patients and families.
• Identifies opportunities for improving patient services.
  
  

Compliance and Education:

• Complies with organizational policies and procedures.
• Completes annual education requirements promptly.
  
  

Regulatory Compliance and Quality Improvement:

• Adheres to state, federal, and Joint Commission regulations.
• Actively participates in performance improvement and quality initiatives.
• Keeps current with principles and practices, regulations, and standards as they apply to healthcare.
  
  

Collaboration and Communication:

• Cooperates with colleagues to achieve departmental goals.
• Adheres to organizational values, ethics, and professional standards.
  
  

Timeliness and Accountability:

• Reports to work punctually and completes tasks within designated timeframes.
• Properly uses identification and timekeeping systems.
  
  

Remember, embodying these expectations contributes to a positive work environment and effective patient care

Core Competencies:

• Values Every Voice. Seeks to understand different perspectives and cultures; contributes to a work climate where the
  
  

contributions of all individuals are valued and supported.

• Shows Courage. Faces difficult issues and supports others who do the same; is willing to campion an idea or position despite
  
  

dissent or political risk; provides direct and actionable feedback.

• Leans Into New Ideas. Learns quickly when facing new situations; experiments to find new solutions and extracts lessons
  
  

learned from failures and mistakes.

• Instills Trust. Follows through on commitments and keeps confidences; is seen as direct and truthful, shows consistency
  
  

between words and actions.

• Plans and aligns. Sets objectives to align with broader organizational goals; breaks down objectives into appropriate
  
  

initiatives and actions; anticipates and adjusts effective contingency plans.

• Builds Effective Teams. Establishes common objectives and a shared mindset; creates a feeling of belonging and strong team
  
  

morale; fosters open dialogue and collaboration among the team.

• Business Insight. Uses knowledge of business drivers to guide actions; keeps up with current and possible future practices
  
  

and trends in the with the competition and in the marketplace.

Qualifications

Qualifications:

Education:

Associate Degree in Nursing, Required

Bachelor Of Science In Nursing, Preferred

Required Licenses:

Must have a current Mississippi Registered Nurse license or a current Compact State Registered Nurse license.

Required Certifications:

• American Heart Association (AHA) Basic Life Support (BLS) Certification required within 90 days of hire or transfer.
• American Case Management Association (AMCA) Accredited Case Manager (ACM) Certification, required within one (1)
  
  

year of hire

Required Skills:

Requirements will include successful completion of orientation checklist and skills/credentials/competency requirements of

specific area of work.

• Demonstrates the values of team concept on a consistent basis.
• Focused on prioritizing the patient’s clinical experience, maintaining a high awareness of patient satisfaction.
• Meticulous attention to detail with the ability to multi-task, while demonstrating proficient time management skills.
• Self-starter who needs no reminders of duties and tasks that need to be completed.
• Able to respond to and cope with emergency situations professionally and calmly.
• Focused, patient and calm, performing well under pressure in a stressful environment and able to take appropriate action.
• Must be flexible, responding to changes in work schedule, able to work as needed for appropriate departmental coverage.
• Must possess knowledge of computer operations and proficiency in Electronic Medical Records (EMR) systems, the use of
  
  

Microsoft Office, email, information systems and other similar software as required.

• Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision.
• Excellent written, verbal and communication skills.
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of
  
  

this job, especially with regard to activities impacting patient or employee safety or security. Additional languages

preferred.

Experience:

Minimum one(1)-two(2) years clinical experience in an acute hospital, clinic, home health, hospice or inpatient mental facility

setting, required.