Case Manager - RN
Education: Graduate of a School of Nursing required; BSN preferred.
Experience: Minimum of five (5) years of experience as a Registered Nurse in acute care required. Case Management/Utilization Review experience preferred.
Licensure/Certifications: Current licensure with the Kentucky Board of Nursing as a Registered Nurse.
Other: The candidate must be a self-starter with the ability to foster teamwork and collaboration to achieve desired results. Must exhibit excellent communication, critical thinking and analytical skills with the ability to exercise discretion and good judgment. Must demonstrate ability to foster mission and CQI values. Knowledge of nursing acute care, compliance, regulatory and accreditation requirements. Self-motivated and directed with the ability to prioritize and work independently with little supervision. Strong interpersonal skills, pleasing personality and positive team player. Proficient in computer skills, software and data analysis.
Under the general supervision of the Manager of Case Management, the Case Manager manages the overall interdisciplinary plan of care for a patient, from admission to discharge. Ensures that the plan of care is medically necessary, timely, coordinated, facilitated and effectively communicated to the physician, healthcare team, and patient to improve quality, safety, satisfaction and effective discharge planning; Communicates and interacts with all levels of professions, including but not limited to physicians, nursing, managers, ancillary staff, and office staff using various professional, appropriate and persistent techniques in a direct yet non-confrontational manner. Acts as a liaison between patient/family and healthcare staff to ensure necessary care is provided promptly and effectively; Uses approved criteria to evaluate severity of illness and medical necessity; Conforms with the requirements of regulatory bodies and all contracted third party payers; Actively participates in RAC and compliance activities; Knowledgeable about acute care standard concepts, practices, and procedures; Actively involved in Clinical Documentation Management Program (CDMP) and Utilization Review services; Relies on experience and judgment to plan and accomplish goals. A certain degree of creativity and latitude is required.
Wednesday, September 23, 2020
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