What are the responsibilities and job description for the OCOM - Nurse Case Manager position at USPI?
EVERY DAY GIVING EXCELLENCE
“Each Patient, Each Family, Each & Every Time”
Our staff is committed to creating an environment in which patients not only receive the best quality care but also the highest level of service. The staff works to continuously improve the processes that are important in meeting the needs of patients, their families, our physicians, and their staff.
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Nurse Case Manager opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!
Overall responsibility:
Collaborates in the process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost effective care.
The case management process begins when the patient enters the health care system continues through discharge planning, discharge and post-discharge follow-up.
The case managers performs utilization management and review functions, peer review relating to utilization review, and follows best practices including CMS, JC and State laws governing medical necessity. All utilization review functions are reported by the case manager to the utilization review committee.
Key tasks and responsibilities
The case manager acts as the Recovery Audit Contractor (RAC) coordinator in the following manner:
1. Pro-actively reviews records and patient admission and treatment plans for medical necessity using evidence based criteria such as InterQual or Milliman.
2. Pro-actively works with physicians to obtain the documentation needed to support medical necessity.
3. Pro-actively monitors admission status for appropriate status orders and communicates needs to the attending physician.
4. Reviews the records requested by RAC for medical necessity and appropriate documentation to support medical necessity.
5. Utilizes physician advisors to assist in the review of RAC requested records.
6. Communicates needs and timely submits complete records to the RAC requesting agency by certified mail.
7. Reports all RAC activity to the PI committee and administration.
Required Skills:
Licensure and Certification:
- BLS, if not current, certification within 90 days of hire.
- Current Oklahoma RN license required.
- Experience in InterQual or Milliman utilization preferred.
- Recovery Audit Contractor process management and appeals experience preferred.
Required Experience:
Previous Experience:
- Previous experience as a Nurse Case Manager is required
Environmental and physical requirements
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The employee works in a temperature controlled environment. Candidate must be able to read and speak English fluently, have cognitive skills for math, reading, computer skills, and communication skills to deal well with the public (customers) as well as peers. Vision for near, mid-range, and far accommodation. Hearing for low, medium and high pitch. Job requires sitting for 70% of activities with minimal up and down activity. Job risk include exposure to computer for 6-7 hours per day with typing activities, lifting of 20-30 pounds maximum, potential for exposure to blood and body fluids (minimal), and exposure to infectious disease.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
