Position Purpose
This clinical position involves working within a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate care options, services, and alternative levels of care to meet individual needs and facilitate appropriate discharge and length of stay. The Case Manager assumes a leadership role within the interdisciplinary team to promote appropriate utilization of care and services, aiming for cost-effective outcomes. Responsibilities include reviewing medical records to ensure timely and appropriate care delivery, with the goal of reducing or eliminating avoidable days.
Nature and Scope
The Case Manager promotes case management activities throughout the health continuum, starting in the acute setting. This involves assessing pre-morbid health status, current medical condition, and post-acute needs. The role includes working closely with the Utilization Management RN for admission and continued stay reviews to ensure services are delivered at the most appropriate care level and reimbursement is secured.
Using an interdisciplinary team 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 across all age groups. The role also involves providing information on certified length of stay and reimbursement issues to physicians to ensure timely client disposition. Monitoring and documenting progress, revising plans as needed, and ensuring smooth transitions to the next care level at discharge are key responsibilities.
Specific Responsibilities:
Excellent documentation and communication skills, critical thinking, quick problem-solving, and escalation when services are not delivered efficiently or appropriately.
Attending rounds and ensuring all orders are written and signed.
Ensuring discharge plans are in place and documented in the system.
Assigning social workers to appropriate patients.
Securing signed choice forms and IMMs 48 hours prior to discharge.
Confirming all team members agree on the discharge plan, date, and care transition plans.
Reviewing charts to ensure all orders are completed and follow-up with physicians.
Completing face-to-face documentation and discharge summaries timely.
Scheduling tests and escalating as needed (labs, imaging, surgery).
Monitoring length of stay to prevent extension beyond appropriate limits.
Managing complex cases requiring specific interventions (wound vac, IV meds, pre-approved medications).
Respecting clients' beliefs and values, advocating for self-determination and informed choices.
Documenting all reviews, identifying potentially avoidable or non-reimbursed days, and communicating quality indicators.
Delivering non-coverage letters as required by payers or regulations.
Maintaining knowledge of post-acute admission criteria and participating in quality improvement initiatives.
This role does not involve direct patient care.
Disclaimer
This description is not exhaustive but reflects the general nature and level of the job.
Minimum Qualifications
Education: Must have working proficiency in English; appropriate education for Nevada RN licensure; Bachelor's in Nursing preferred.
Experience: One year RN experience preferred; case management, post-acute, or UR/QA experience preferred.
License: Ability to obtain and maintain Nevada RN license.
Certifications: CCM, CPUR, or NMCC preferred; current BLS/CPR required.
Computer Skills: Proficiency with Microsoft Office Suite and ability to complete online learning and forms.