Travel Nurse RN - Case Management
Hyannis, MA
Trusted Talent
Days

Purpose of Position
The Case Manager is responsible for the timely facilitation and coordination of care for a specific patient population or area of assignment. Responsibilities include working effectively with the interdisciplinary team to plan and implement an individualized program of care that promotes high quality, efficient, and cost-effective care. The Case Manager must assess patient needs utilizing established standards, Care Maps, and other approved clinical guidelines. Through ongoing communication and coordination with third-party representatives, the Case Manager facilitates care to meet established patient needs.

Key Responsibilities
- Screen new admissions daily for discharge planning needs. - Establish priorities for visits based on screening criteria. - Verify accuracy of demographics and payer information and notify admissions of corrections. - Ensure patients with identified needs for follow-up are seen promptly, completing the Initial Assessment in the appropriate system. - Conduct reassessments every few days as needed for changes in medical status or care needs. - Review appropriateness of patient admissions and level of care, following policy if criteria are not met. - Initiate timely notices and letters of reinstatement as necessary. - Coordinate patient appeal rights under the Discharge Appeals program. - Identify patients and families with complex psychosocial, financial, and legal needs and refer them to appropriate resources. - Responsible for utilization review on the assigned unit. - Facilitate third-party reimbursement by providing necessary clinical information. - Work closely with the attending physician and interdisciplinary team to ensure appropriate care and services. - Ensure that the interdisciplinary care plan and discharge plan meet patient needs. - Participate in daily rounds and care conferences. - Advocate for patients, developing partnerships with families, payers, and healthcare teams. - Coordinate and communicate referral information for safe patient transfer. - Complete necessary paperwork per regulations. - Act as a resource for staff providing safe and effective post-hospital care. - Participate in the development, application, and revision of care standards and clinical pathways. - Assist medical coders in obtaining diagnostic and procedural information. - Maintain departmental policies, objectives, and quality assurance standards. - Stay informed of regulatory and payer requirements. - Participate in education programs and meetings as required. - Demonstrate responsibility and initiative in daily duties. - Maintain professional demeanor and adhere to dress code policies. - Provide service excellence to all patients, family members, visitors, volunteers, and co-workers.

Qualifications
- Minimum of 3 years of acute care experience within the past 5 years. - Working knowledge of InterQual or equivalent systems. - Recent experience in Discharge Planning and Utilization review within the past 4 years. - Proficient in English communication. - Bachelor of Science Degree in Nursing preferred. - Certification in Case Management or CPUM preferred. - Strong interpersonal and negotiation skills. - Excellent organization and time management skills. - Ability to work independently in a fast-paced environment. - Effective in handling multiple projects and changing priorities. - Proficient computer skills with the ability to integrate updated software systems into practice.

Must-Have Skills
Acute Care; InterQual