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Case Manager RN 3 (U)
Location
United States
Posted
3 days ago
Salary
0
Seniority
Lead
No structured requirement data.
Job Description
Case Manager RN 3 (U)
University of Miami
Role Description The Case Manager RN (U) coordinates the overall interdisciplinary plan of care for patients, from admission to discharge. Responsibilities include: - Monitors care and acts as a liaison between patient/family, healthcare personnel, and insurers. - Evaluates the needs of the patient, the resources available, and recommends and facilitates the plan for the best outcome. - Develops a discharge plan that provides the best available resources to meet ongoing patient needs and encourages compliance with medical advice. - Identifies patient care issues and suggests revisions to or new clinical pathways to improve quality of care. - Facilitates care for all assigned patients including extended recovery, outpatient observation, and inpatient admissions. - Assures timely consultations and testing facilitation. - Ensures social service intervention and individual discharge planning based on patient needs and insurance coverage. - Incorporates fundamental principles of monitoring resource consumption and capture of avoidable days. - Enters Ancillary notes utilizing templates for care facilitation. - Proactively assures needed orders are obtained and facilitates delivery of clinical and community services. - Attends daily multidisciplinary huddles and facilitates meetings to address progression of care. - Ensures appropriateness and cost-effectiveness of the patient’s plan of care based on DRG. - Collaborates with physicians to develop patient care plans and review medical needs for continued hospital services. - Utilizes Case Manager nurse driven protocols to facilitate care and request physician orders. - Provides all required Medicare documents to the patient and/or proxy when applicable. - Processes QIO Medicare appeals. - Handles acute care transfers including psychiatric transfers. - Reports on assigned LOS 10-day outliers during Complex Case Review. - Communicates daily with management on observation outliers related to care transition and discharge barriers. - Identifies patients’ risk factors or obstacles to care, and discharge and readmission risk. - Evaluates the plan of care regularly by chart review and patient interviews. - Educates patients and families on the progression of care. - Serves as a liaison to ensure necessary care is provided promptly and effectively. - Promotes quality care to ensure patients receive medically appropriate services. - Facilitates regulatory notifications and patient signatures per policy. - Maintains knowledge regarding insurance reimbursement policies. - Plans and facilitates discharge and transition plans to meet the physical, social, and emotional needs of the patient. - Adheres to University and unit-level policies and procedures. Qualifications - Bachelor’s Degree in relevant field. - Registered Nurse Licensing (RN). - Minimum 7 years of relevant experience (5 years of case management/utilization review experience). - Ability to communicate effectively in both oral and written form. - Ability to recognize, analyze, and solve a variety of problems. - Ability to analyze, organize, and prioritize work under pressure while meeting deadlines. - Ability to maintain effective interpersonal relationships. Benefits - Competitive salaries. - Comprehensive benefits package including medical, dental, tuition remission, and more. Company Description UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by groundbreaking research and medical education at the Miller School of Medicine. As an academic medical center, we serve South Florida, Latin America, and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, with over one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research, and patient care.
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