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Case Manager

Company: Southwestern Medical Center
Location: Lawton
Posted on: January 24, 2023

Job Description:


  • Position Summary


    The role of the Hospital RN Case Manager (CM) is to increase patient through-put to the most appropriate level of care while facilitating interdisciplinary care across the continuum. The CM will assist in identifying patients appropriate for Admission, Observation or other patient status. The CM will function as a liaison between physicians, physician advisors, other professional staff, residential or nursing facilities, community agencies, patients and families and department staff. The role includes the management of social issues that impact the current and anticipated ongoing needs of the patient. The CM will assist in identifying physician and staff documentation opportunities to support Quality and reimbursement indicators.



    ESSENTIAL FUNCTIONS:


  • Demonstrates knowledge of case management principles and standards of practice as evidenced by compliance with applicable regulations.
  • Perform admission and concurrent stay reviews, utilizing InterQual criteria for appropriate level of care assignment.
  • Monitors and facilitates appropriate utilization of tests/procedures, consultations, treatment plans, and resource utilization. Discusses findings with healthcare team and facilitates referrals as indicated.
  • Anticipates barriers/variances to the delivery of care; intervenes as necessary.
  • Serves as a resource to patients, physicians, Administration and hospital employees regarding issues related to patient classification and reimbursement.
  • Refers inappropriate Observation or anticipated Admission cases to the Physician Advisor/Representative.
  • Provide real time interventions to prevent delays and ensure compliance with healthcare regulations and revenue integrity.
  • Communicates with payers as required to facilitate reimbursement and denial avoidance.
  • Functions as a liaison between Physician and Physician Advisors.
  • Identify documentation opportunities, support core measures and other quality or payment indicators.
  • Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure optimal patient outcomes.
  • Documents and reports data for process improvement to include avoidable delays and denials.
  • Coordinates discharge planning via screening and assessments to identify post-acute care needs.
  • Collaborates with patients and/or designated decision makers to establish goals for discharge and post-acute care needs.
  • Identifies variances in discharge expectations and facilitates team conference for review and re-establishment of appropriate goals.
  • Makes referrals or delegates discharge needs to members of the health care team as appropriate.
  • Facilitates the initiation of post-acute care needs.
  • Participates in defining, maintaining and interpreting standards of practice as they relate to case management.
  • Demonstrates competence in the assessment, range of treatment, knowledge of growth and development and communication, appropriate to the age and functional status of the patient.
  • Maintains confidentiality of all materials handled within the hospital, as well as the proper release of information
  • Demonstrates/model the hospital's core values and customer service behaviors in interactions with all customers (internal and external)
  • Complies with hospital and departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements.
  • Demonstrates financial responsibility and accountability through the effective and efficient use of resources in daily procedures, processes and practices


Keywords: Southwestern Medical Center, Lawton , Case Manager, Executive , Lawton, Oklahoma

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