Full-Time, 40 hours per week. The Case Manager position is a combination of discharge planning and utilization review. The case manager works hand in hand as a liaison between the patients, hospital staff, medical staff, and the community to assist in establishing a safe discharge plan and appropriate utilization of medical care in order to achieve optimal level of health. The Case Manager ensures proper payment of services from insurance plans by obtaining prior authorization of services and concurrent review of inpatient stays.
JOB DUTIES & RESPONSIBILITIES:
- Coordinates care/services for a designated patient population (venue specific and/or across the continuum) to assure high quality, cost-effect outcomes.
- Examines patient’s charts to evaluate appropriateness of admission by determining the severity of illness and the intensity of services reflected in the nurse’s admission assessment, and the health care providers’ treatment orders to meet government, intermediary and regulatory requirements.
- Assess discharge planning needs for the patient early in the hospital stay.
- Facilitates communication and coordination between members of health care team.
- Provides consultation and educational services to health care providers and patients/families to improve the outcomes of care.
- Analyzes and reports data for assigned patient Population(s) and collaborates with health care team members to make necessary improvements.
- Performs basic administrative tasks related to the job, such as time planning, recording, preparing reports, and other routines as required by the department.
- Manages skilled nursing care and Utilization Review.
- Participates in on going quality improvement projects.
QUALIFICATIONS:
- Graduate of an accredited school/college of nursing
- Currently licensed as a Registered Nurse in the State of Nebraska
- Basic Life Support (BLS)
- Good understanding of community health, welfare and social agencies
- Ability to relate to and appropriately adapt to various levels of behavioral and physical needs
- Previous experience as a Case Manager or Social Worker preferred