Position Purpose
This clinical position collaborates within a team to assess, plan, implement, coordinate, monitor, and evaluate care options, services, and levels of care to meet individual needs and facilitate appropriate discharge and length of stay. The Case Manager leads interdisciplinary efforts to promote appropriate utilization of care and services, ensuring cost-effective outcomes. Responsibilities include reviewing medical records to ensure timely and appropriate care delivery, aiming to reduce or eliminate avoidable days.
Nature and Scope
The Case Manager promotes case management activities across the health continuum, starting in the acute setting. This involves assessing pre-morbid health, current medical status, and post-acute needs. Working closely with the Utilization Management RN, they perform admission and continued stay reviews to ensure services are delivered at the appropriate care level and reimbursement is secured.
Using an interdisciplinary approach, the Case Manager acts as a consultant and educator on alternative care levels and managed care issues. They collaborate to provide optimal patient care through assessment, planning, implementation, and evaluation for neonatal, pediatric, adolescent, adult, and geriatric patients and families. They also provide information on certified length of stay and reimbursement to physicians to facilitate timely client disposition. Monitoring and documenting progress, they revise plans as needed to ensure smooth transitions at discharge.
Specific Responsibilities:
Excellent documentation and communication skills, critical thinking, quick problem-solving, and escalation when services are inefficient or inappropriate.
Participate in rounds and ensure all orders are written and signed.
Ensure discharge plans are in place, documented, and in the computer system.
Assign social workers to appropriate patients.
Obtain signed choice forms and IMMs 48 hours prior to discharge.
Ensure all team members agree on discharge plans, dates, and care transition strategies.
Review charts to confirm all orders are completed, signed, and follow up with physicians.
Complete face-to-face documentation and discharge summaries timely.
Ensure timely scheduling of tests such as labs, imaging, and surgeries, escalating as needed.
Monitor length of stay to prevent unnecessary extension beyond approved durations.
Handle clinically complex cases requiring specific interventions (e.g., wound vac, IV meds, pre-approved medications).
Respect patient beliefs and values, advocating for self-determination and informed choices.
Document all reviews, identify potentially avoidable or non-reimbursed days, and communicate quality indicators like re-admissions. Deliver non-coverage letters as required by payers or regulations.
Maintain knowledge of post-acute admission criteria (Rehab, LTAC, SNF) and participate in Quality Improvement initiatives.
This position does not involve direct patient care.
Disclaimer
The description is not exhaustive of all responsibilities, skills, or work conditions but reflects the general nature and level of the job.
Minimum Qualifications
Education: Must have working knowledge of English, with appropriate education for Nevada RN licensure. BSN preferred.
Experience: One year as an RN preferred; experience in case management, post-acute care, or UR/QA preferred.
License: Ability to obtain and maintain Nevada RN license.
Certifications: CCM, CPUR, or NMCC preferred; current BLS/CPR required.
Computer Skills: Proficiency in Microsoft Office Suite and ability to complete online learning and forms.