RN Case Manager Level II
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El Dorado, KS 67042
1. Performs Utilization Review for medical necessity of admission and continued inpatient hospitalization for the Medical/Surgical, Skilled Care Program, TLC and medically complicated OB patients. 2. Completes utilization review sheet within one working day of admission. Identifies severity of illness and intensity of service by documenting on worksheet. Performs continued stay review at least every third day thereafter. 3. Conducts telephone utilization review with contracted utilization review companies as requested. Provides patient insurance preauthorization numbers to Business Office personnel as required. 4. Functions as the leader of the Med/Surg/Skilled Care Program Discharge Planning Teams and attends meetings as scheduled. 5. Serves as a liaison to facilitate communication between members of the Discharge Planning Team: Rehabilitation, Nursing Services, Dietary, Pastoral Care, Social Work, Pharmacy and physicians. 6. Serves as a leader and/or member of quality improvement teams as requested. Facilitates follow-through in team decisions and changes in policy. Serves as a resource for teams as requested. 7. Communicates with attending physicians or physician advisor regarding medical necessity of admission or continued stay and discharge plans. 8. Provides information regarding status/availability of inpatient Medicare days as required by the Discharge Planning Teams. 9. Promotes client self-determination and self-advocacy. 10. Makes appropriate referrals to other health care providers with patient’s authorization. 11. Serves as primary discharge planner/case manager for patient’s with CHF, COPD, diabetes or other identified chronic illnesses as a primary diagnosis. 12. Maintains timely, accurate documentation in accordance with hospital, state, and federal agency requirements. 13. Documents pertinent information, goals, interventions, and notes. 14. Develops and maintains a good working rapport with inter-departmental personnel and community resources. 15. Participates in departmental meetings, case management and discharge planning conferences, in-service programs and acts as a consultant to other hospital personnel. 16. Participates in hospital and departmental performance improvement endeavors. 17. Develops and maintains a knowledge of chronic, acute and terminal illnesses, physical disabilities and the resultant age-specific impact on individual and family systems. 18. Participates in meetings, workshops and seminars to improve case management and utilization review skills and knowledge of community resources. 19. Understands the importance of and promotes confidentiality. 20. Demonstrates knowledge of and compliance with department and hospital policies and procedures. 21. Participates in the orientation and education of newly hired social workers and nursing personnel. 22. Other duties as assigned by the Social Work Director. 23. Prepares and distributes “Notice of Denial” letters to patients and/or families within established deadlines. 24. Provide assessment of the social, emotional, environmental, functional, physical and mental health status of the assigned patient. 25. Promotes Susan B. Allen programs by participating as a consultant to existing programs and by providing community education programs in social work areas of expertise. 26. Performs other duties as assigned.
II. JOB DESCRIPTION: QUALIFICATIONS Knowledge, Skills, and Abilities: Ability to work independently with minimal supervision. Ability to work with management and staff. Ability to review medical records, evaluate findings and make a standard of care determination. RN with a wide variety of clinical experience and knowledge of nursing and ancillary services (PT, RT, etc.). Good organizational skills with good understanding of hospital organization, JCAHO standards relating to quality improvement laws; basic typing skills and computer knowledge required. Must have excellent verbal communication skills, including the ability to work well with patients, families, professionals in house, and outside agencies. Recent experience in preferred. Working knowledge of community resources. Will be oriented to, and maintain competence in working with patients in the following age categories: Med/Surg. ICU: Infant, Pediatric, Adolescent, Adult, and Geriatric Patients OB: Neonate, Adolescent, and Adult Patients ER: Neonate, Infant, Pediatric, Adolescent, Adult, and Geriatric Patients SCP: Geriatric Patients
TLC: Geriatric and chronically mentally ill patients Education: Graduate of an accredited school of nursing with licensure to practice nursing in the state of Kansas. BSN or MSN preferred. Experience: RN with a wide variety of clinical experience and knowledge of nursing and ancillary services, Rehab, Respiratory Care, etc. One year of Utilization Review or Case Management experience required, 5 years preferred. Certification/Licensure: RN. Must possess evidence of current Kansas license or eligibility for licensure exam or valid temporary permit to practice, if coming from out of state. Case Management certification preferred. Code Blue Training: Ability to activate Code Blue system by dialing 200.
II. JOB DESCRIPTION: PHYSICAL DEMANDS May require frequent sitting. Requires frequent standing and walking. Occasionally lifts and carries up to 10 lbs. May require pushing and pulling up to 10 lbs. Eye hand coordination, finger and manual dexterity are required. Requires corrected hearing and vision to normal range. Requires working under stressful conditions. Some exposure to hazardous materials is required. Requires occasional grasping, twisting, climbing, balancing, stooping, kneeling and reaching. Requires the ability to distinguish letters or symbols. Ability to use office equipment such as computer terminal, typewriter, telephones, copiers and fax machine. Repetitive movements involved in typing, writing and keyboard entry are required. Job requires working under stressful conditions and/or irregular hours. Some exposure to communicable diseases, sharps, and hazardous material is anticipated. Job requires potential exposure to body fluids and radiation.
II. JOB DESCRIPTION: WORKING CONDITIONS Work is predominately scheduled 7:00-3:30 or 8:00-4:30 Monday through Friday. However, attendance may be required on weekends and after business work hours. Work schedule may vary to accommodate patients and families. The nurse case manager will participate in on call rotation with Social Workers. Social Work department staff are available through the on-call pager 24hour 7 days, including holidays.