Case Manager RN (Temporary, Remote. Day shift)

What You’ll Be Doing

Responsibilities Include but are not limited to:

• Conducts utilization review using MCG criteria
• Promotes appropriate utilization of resources
• Participates in and supports Case Management Department initiatives
• Determines that an already-admitted patient does not meet inpatient criteria (Medicare: Code 44, OBSV)
• Escalates level of care concerns to Case Management Director and /or Physician Advisor
• Coordinates with the Patient Access team to obtain and monitor timely notices of admission for clinical review

By first business day following admission:

• Reviews admissions for appropriateness. Concurrent and retrospective admission reviews are done in accordance with MCG criteria regardless of insurance coverage or patient’s ability to pay.
  • Provides Initial Clinical Review to Commercial insurance companies as indicated.
  • Contacts Physician Advisor when review criteria is not met.

During patient hospitalization:

• Monitors patient’s electronic medical record to determine continued stay appropriateness.
• Completes continued stay review in AllScripts at least every third business day.
• Contacts Physician Advisor when criteria is not met.
• Identifies factors delaying discharge and facilitates correction.

• The Case Management documentation in the EMR will be the basis for peer review and patient care evaluation studies.

Each entry must be properly identified as a case management note. Every entry in the EMR must be e-signed at the time of documentation. Progress notes should show clear connections and be specific. Abbreviations should be avoided and conform to hospital policy.

What We’re Looking For

Education: Bachelor’s degree in social work related field.

Experience: 2 + years related experience.

Skills: Excellent interpersonal and communication skills.