What are the responsibilities and job description for the RN Case Manager - Full Time position at United Surgical Partners International Inc (USPI)?
Arizona Specialty Hospital is seeking an experienced Registered Nurse Case Manager to join our team! This position is full time.
The RN Case Manager responsibilities include :
- Working independently while handling multiple priorities simultaneously.
- Utilizes the nursing process of assessment, planning, implementation and evaluation to direct or provide nursing care.
- Manages patients across the healthcare continuum to achieve optimal clinical, financial, operational and satisfaction outcomes.
- Assess the patients’ plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care.
- Active participant in the interdisciplinary healthcare team to promote / facilitate discharge planning, facilitating options and services to meet patients’ health care needs.
- Identifies and intervenes when necessary to ensure efficient and cost-effective delivery of patient care services.
- Coordinates the necessity of case management and utilization review for any patient at AZSH.
- Provides requested documentation to payors in a timely manner.
- Establishes and promotes collaborative relationships with physicians, patients, families and additional members of the healthcare team.
- Educates members of the healthcare team on case management and managed care concepts.
- Review medical necessity and coordinate with the interdisciplinary team to assure correct status for payment.
- Assist with clinical interpretation for denial and appeals management.
- Knowledgeable about Medicare, Medicaid, and commercial insurance plans.
- Strong analytical, organizational, and time management skills.
- Experience with InterQual and or MCG
- EMR Experience
Required Skills
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Required Experience
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