What are the responsibilities and job description for the CASE MANAGER (RN) position at WMC Health Network?
The Case Manager (RN) is responsible for implementing and supervising the day-to-day operations of the Case Management programs at Bon Secours Charity Health System. This position manages activities necessary to ensure appropriate utilization of the Hospital and its resources while maintaining optimal standards of patient care.
RESPONSIBILITIES :
- Oversees the patient assessment process within the Case Management department to identify pertinent / potential patient problems.
- Addresses needs of the patients through direct interaction with the staff, physicians, patient's, and families including screening / reviewing of the patient's medical records.
- Determines appropriateness of admission and severity of illness compared to pre-established criteria standards utilized by all third party payors.
- Monitors the collaboration with multidisciplinary care management team regarding the individualization of the patient care plan in order to promote efficient use of hospital resources, facilitate timely discharges, and promote quality care.
- Oversees the collection of clinical data, based on predetermined quality and outcome indicators developed by the medical staff, case management director and administration.
- Provides orientation / mentoring to staff, completes scheduling, and evaluations within the Case Management department.
- Performs other related duties for the Case Management department.
QUALIFICATIONS / REQUIREMENTS :
Minimum of three year's hospital case management experience. Current licensure in the State of New York as a Registered Nurse. Understanding of Medicare / Medicaid criteria and insurance regulations and reimbursement.
EDUCATION :
A Bachelor's of Science in Nursing, preferred
OTHER :
If applicable, the individual performing this job may reasonably anticipate coming into contact with human blood and other potentially infectious materials. Individuals in this position are required to exercise universal precautions, use personal protective equipment and devices, and learn the policies concerning infection control.
