Increases patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum while maintaining regularity compliance. The role Integrates, coordinates care facilitation throughput while working in partnership with the healthcare team. Is accountable for prioritizing, reviewing cases to determine the appropriateness of pre-admission, admission utilizing payer established criteria Assisting in identifying appropriate patient status and level of care. Identify readmissions managing per policy. Identify possible inappropriate hospitalizations and collaborate with the healthcare team to facilitate alternate Level of Care. Assist in identifying physician and staff documentation opportunities to support Quality and Pay for Performance indicators.
Estimated pay range for this position is $32 - $44 / hour depending on experience.
Degrees: Associates Licenses & Certifications: NACCM Care Manager Certified ACMA ACM Certification RNCB Certified Rehabilitation Registered Nurse ANCC Nursing Case Management CDMS Certified Disability Management Specialist CCMC Case Manager NBCC Certification in Continuity of Care, Advanced ABMCM Certified Managed Care Nurse Registered Nurse Additional Qualifications: RNs hired prior to 2/2012 with an Associate Degree are not required to have a BSN to continue their non-leadership role as an RN, however, required to complete the BSN within 5 years. A Case Management Certification required within 12 months of hire. 3 years of hospital clinical experience with a minimum of 1-3 years of hospital or payor Case management or Utilization management review experience preferred. Excellent interpersonal communication and negotiation skills. Strong analytical, data management and computer skills. Current working knowledge of discharge planning, utilization management, case management and performance improvement preferred. Understanding of pre-acute and post-acute venues of care and post-community resources preferred. Strong organizational and time management skills. Ability to work independently and exercise sound judgment. Ability to prioritize and manage multiple high-risk, complex patients. Ability to work with multiple members of a care team and maintain positive working relationships. Demonstrate the ability to solve problems in a fast-paced environment. Minimum Required Experience: 3
- Ciac Certified Management Consultant
- Case Management
- Certified Disability Management Specialist
- Certified Managed Care Nurse
- Certified Nurse Practitioner