RN Case Manager

Overview

Provides discharge planning and utilization review services in compliance with patients discharge planning needs and the hospital’s utilization review program. Coordinates and manages the facility's Swing Bed program. Coordinatees Employee Health program.

SAFETY SENSITIVE POSITION:

This position is a designated as “Safety Sensitive Position” under Act 593 of the State of Arkansas. An employee who is under the influence of Marijuana constitutes a threat to patients/customers which Conway Regional is responsible for in providing and supporting the delivery health care related services.

Qualifications

- Registered Nurse, licensed to practice in Arkansas OR

- At least one-year experience in the area of case management/utilization review, preferred.

- Must maintain Basic Life Support (BLS) and Advanced Cardiac Liffe Support (ACLS)

- Excellent written and verbal communication skills to include computer knowledge

Responsibilities

Case Manager:

Serves as liasion between patients, their families, physicians, and other health care personnel.

Responsible for discharge planning of all Acute Care patients.

Conducts Discharge Planning Meetings per Arkansas Department of Health (ADH) Rules and Regulations.

Collaborates with Utilization Review of all Acute Care patient services.

Participates in appropriate department/hospital committees and meetings.

Investigates and resolves complaints or refers problems to appropriate Manager/Director.

Maintains positive relationships with other Case Managers, and contacts at area facilities.

Developments and implements QI data. Reports data to leadership and quality council.

Promptly responds to all questions/issues related to case management and utlization review.

Collaborates in problem solving; works with other departments to achieve common goals that best meet the customer needs and expectations.

Exchanges information willingly and in a timely manner to achieve shared objectives, keeps other informed.

Adheres to the provisions of the Compliance program.

Knowledge of CMS utilization review requirements.

Knowledge off community resources related to discharge planning.

Medical record review. Obtains and maintains medical records in conformance with Medical Information policies.

Responsible for analysis of patient information for determination of medical necessity of admission or continuation of stay.

Review for medical necessity of admission on the first working day after admission using approved review criteria.

Reviews inaptient procedures to determine appropriate utilization and acuity level.

Performs retroactive reviews, as necessary, and responds to the appropriate review agency or third-party payor.

Researches denials issued by review agencies and third-party payors and responds within the specified time frames for appeal.

Participates in the weekend call rotation for nursing management.

Other duties and responsibilities as assigned by management.

Swing Bed Coordinator:

Coordinate the admission and referral process for Swing Bed patients from initial referral through admission and discharge.

Serve as the primary point of contact for hospitals, discharge planners, case managers, physicians, patients, and families regarding Swing Bed referrals.

Review referrals and gather required clinical, demographic insurance, and other admission information.

Coordinate with nursing, therapy, dietary, billing and other departments to facilitate timely admissions.

Monitor referral status and follow up promptly on pending refferrals and potential admissions.

Assist with insurance verification, prior authorization, and other payer requirements as applicable.

Maintain accurate and timely documentation related to referrals, admissions, and patient transitions.

Track Swing bed census, referrals, admissions, discharges, and referral outcomes.

Develop and maintain professional relationships with hospitals, physicians, physician offices, discharge planners, case managers, social workers, home health agencies, hospice providers, and other referral sources.

Communicate the facility's Swing Bed rehabilitation, nursing and other applicable services to referral sources and the community.

Work with leadership to develop and implement census-building and community outreach strategies.

Employee Health:

Coordinates the employee health program for DRMC.

Coordinates policies and planning for the employee health program with hospital leadership, infection prevention, pharmacy, other departments and relative external agencies.

Coordinates all employee health required vaccinations, immunizations, and post exposure prophylaxis.

Conducts personnel health assessments on an as needed basis as required to evaluate work related illness or exposures to infectious diseases.

Investigate, assess and follow up on work related injuries & illnesses. Assist employees in obtaining medical care as needed for work related illnesses or injury.

Maintains a record on health care personnel that includes information obtained during the health screening, immunization records, results of tests obtained in any screening or control programs, and reports of work-related illnesses, injuries or exposures in accordance with state and federal regulatory requirements.

Ensures that Employee Health policies are current and revised annually.

Adheres to local, state and federal regulations pertaining to Employee Health.

Notifies Infection Prevention Nurse of infections in personnel that require work restrictions or exclusion from work, work related infections & exposures & clearance for work after an infectious illness that required work restrictions or exclusion.