Company: Southwestern Medical Center
Posted on: January 24, 2023
- 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.
- Demonstrates knowledge of case management principles and
standards of practice as evidenced by compliance with applicable
- Perform admission and concurrent stay reviews, utilizing
InterQual criteria for appropriate level of care
- 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
- Communicates with payers as required to facilitate
reimbursement and denial avoidance.
- Functions as a liaison between Physician and Physician
- 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
- 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
- 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
- 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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