Description
The RN – Case Management will be utilized as either Utilization Management or as Discharge Planning. The Case Manager tasked with discharge planning shall coordinate care of an assigned caseload of patients through collaboration with physicians, nursing staff, and other health professionals to facilitate efficient utilization of clinical resources, optimal clinical and continuing care, as well as financial outcomes. This individual shall be responsible for providing a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive human service needs through communication and available resources.
The Case Manager tasked with utilization management shall work in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payers), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness. This individual shall work collaboratively with other Clinical Care staff to ensure patient needs are met and care delivery is coordinated across the continuum. The RN will complete admission, continued stay, and discharge reviews in accordance with federal regulations, Insurance guidelines and Baptist Health's Utilization Management Plan. In addition, the RN is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity. This position may have additional duties assigned that are within scope of the role. https://www.baptistfirst.org/careers
Requirements
Education / Experience: Degree in Nursing, Bachelor's degree preferred. At least 2 years hospital patient care experienced required. Previous experience in home care, reimbursement, or hospital insurance preferred. Previous inpatient hospital case management experience including utilization review (third party payor reimbursement, DRGs), and home care.
License / Certification: Active RN license required, Case Manager certification preferred
Knowledge, Skills, and Abilities:
Must possess basic computer skills.
Strong oral, written and interpersonal skills.
Ability to work independently with minimal supervision.
Must be able to function in high-stress environment subject to frequent interruptions and changing priorities.
Knowledgeable in use of appropriate infection control or isolation techniques when necessary.
