RN Case Manager
Hyannis, MA
Navitas Healthcare
5x8 hrs, Days
Retention Bonus

Purpose of Position

The Case Manager is responsible for the timely facilitation and coordination of patient care for specific patient population or area of assignment.

The job responsibilities include working effectively with the interdisciplinary team so as 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 will facilitate care that will meet established patient care needs while optimizing reimbursement.

Description

Screen new admissions daily for discharge planning needs.

Establish priority of visits based on screening criteria.

Verify accuracy of demographics and payer information in and notify admissions of corrections.

Patients with identified needs for follow-up are seen within one (1) business day of identification and the Initial Assessment is completed in InterQual®.

Reassessments are done every three (3) days as needed for changes in medical status, diagnosis, or caregiver.

Review appropriateness of patient's admission and level of care needs (Inpatient and Observation) utilizing InterQual® Criteria. Follow policy and procedure if Level of Care is not met.

Initiates timely HINN Notices and letters of reinstatement.

Coordinates patient appeal rights under the Discharge Appeals program.

Identifies patients and families who have high-risk complex psychosocial/financial and legal needs and refers patients to appropriate resources.

Responsible for utilization review on assigned unit.

Facilitates third party reimbursement by responding to third party payer requests for concurrent clinical information in support of ongoing services, turnaround time by day end.

Works closely with attending physician/interdisciplinar