Registered Nurse Case Manager (Utilization Review) - Full Time - HCA (San Antonio Live Oak, Texas)
General Statement of Duties:
The Case Manager will work with patient/families identified to have discharge planning, psychosocial, financial or other needs to develop a plan that will:
1) Optimize functional and self-care abilities;
2) facilitate system access and appropriate utilization of services;
3) facilitate communication and coordination of efforts among health care team members; and
4) promote quality, cost effective outcomes. The Case Manager will demonstrate knowledge and skills necessary to develop a plan based on physical, psychosocial, educational and age related criteria
Essential Job Functions:
1. Assesses by interview and charts review discharge needs of all high-risk patients (and others referred). Identifies resources available to address the needs identified, coordinate referrals and document plan.
2. Utilize community resources to support patient’s post hospital needs. Documents choice in available resources has been offered.
3. Performs admission and continued stay reviews. Provides clinical information to payers upon request for certification and reimbursement of care. Discusses alternate level of care with physician. Refers cases not meeting acute care criteria to Physician Advisor as needed.
4. Facilitates and or provides education of hospital staff, physicians, patients and caregivers for purposes of efficient resource utilization
5. Keeps current of requirements by JCAHO, HCFA and other state/federal agencies on provision of care, planning and documenting.
6. Tracks resource statistics to identify improvement opportunities. Attends medical staff and other hospital committee meetings to report findings.
Click here for more info: https://hca.taleo.net/careersection/0hca/jobdetail.ftl?job=01574-73136&lang=en
• Post ID: 25116908 sanantonio