RN CASE MANAGER 36hr

Description

Status: 36hr/wk

Job Summary:

The Case Manager is accountable for the organization, and resources that are necessary and appropriate for the achievement of patient outcomes within effective time frames. In addition, the Case Manager will coordinate the plan of care among all members of the health care team. Must have ability to practice under minimal supervision to perform the following four essential activities of Case Management: Assessment, Planning, Implementation and Coordination. The Case Manager must assist to reduce practice variations and enhance patient outcomes.

Essential Duties:

Assessment

1. Completes the assessment process to identify individual needs and develops a comprehensive case management plan. Gathers information from, but not limited to, patient, family, professional and non-professional care givers, employers and/or health records.
2. Regularly monitors information relevant to the case management plan. Concurrent reviews are conducted every 1-3 days for ongoing intensity of service, appropriateness of setting and discharge planning.
3. Consistently evaluates the case management plan’s effectiveness including reassessment for any significant decline in status and subsequent new planning required prior to discharge.
4. Assesses age-specific data regarding patient needs.

Planning

1. Completes the planning process to determine specific objectives, goals, and actions designed to meet the patient’s needs.
2. Implements the Case Manager’s plan in a timely manner to facilitate accomplishment of the plan objective and goals involving the Physician advisor, as necessary.

Implementation

1. Coordinates and integrates resources as necessary to accomplish the goal of the case management plan with the patient as well as facilitates the Interdisciplinary Team Meetings (ITMs).
2. Maintains a ready and current working knowledge of insurance, reimbursement structure, network provider list, approval criteria, and appeals process.
3. The Case Manager conducts all negotiations for approval/authorization of services and is accountable to conduct/facilitate with the Physician and/or Physician advisor all Appeals, or denials received. The Case Manager establishes a professional and productive working relationship with payer source case managers.

Coordination

1. Interacts with all members of the health care team, acts as a consultant to other personnel and functions as a liaison among patient, family, and other health care staff throughout the continuum of care.
2. Monitors Resource Management protocols and monitors avoidable delays.

Other Duties:

1. Complies with local, state, and federal laws and regulations.

Requirements

1. Must have an active valid Maine RN license.
2. Preferred RN experience of 2 to 3 years.
3. Working knowledge of criteria used to assess levels of care within 1 month of hire.
4. Meets the unit’s annual competency training requirements.
5. Obtains BLS certification within 3 months of hire and maintain certification thereafter. 
6. 6. Obtains ACLS certification within 1 year of hire and maintain certification thereafter.