Case Manager RN – Women's Health – Casual
Case Manager RN - Women's Health - Casual - Sheboygan Memorial
Job Description ? Serves as an educator and resource to the medical staff and hospital staff regarding hospital resource utilization issues and relevant regulatory requirements. ? Collaborates with physicians daily regarding patient care course. Makes suggestions in expediting care and modification to a tentative plan on a timely basis, if necessary. ? May work as a member of the Outcome Facilitation Team (OFT) in a collaborative and proactive manner to promote best practice. Along with the Patient Care Manager and Clinical Nurse Specialist of the unit, proactively works to achieve the objectives outlined in the multidisciplinary Outcome Facilitation Team meetings ? Responsible to collaborate with peers in the work group to ensure timely completion of essential functions. May provide some work direction to secretaries as needed. ? Facilitates communications between and negotiates with the patient/family, physicians, nurses, dietary, rehab, homecare, social services, and other disciplines that need to collaborate to provide care for the patient. ? Identifies, evaluates, and acts to resolve any potential barriers to delivery of care and a timely and appropriate discharge. May coordinate and document discharge plans of care ? Conducts concurrent and retrospective clinical review based upon pre-established criteria approved by the Medical Staff for admission appropriateness and avoidable day(s) surveillance. ? Collects accurate data on outcomes and resource utilization issues and facilitates reporting of utilization monitoring/review activities to the appropriate committees/persons on a quarterly basis. ? Provides clinical updates for the purpose of obtaining certification to third party payers and fourth party external review groups, as stipulated in contractual agreements. Responds to and coordinates appeals as appropriate, for denials in coverage. ? Works closely with the medical staff, hospital departments and ancillary services in expediting care delivery and appropriate documentation to avoid delays in timely service provision. Validates care that is provided. ? Collaborates as a partner with jointly assigned Social Worker to ensure safe and appropriate discharge planning. ? Promotes effective professional relationships with physicians, other department members and hospital staff; facilitates problem solving, as appropriate.