Case Manager, RN

Case Manager

The Case Manager supports patients, families, and payer representatives, medical and allied health team personnel. The position aims to achieve optimal, timely, and durable patient outcomes, customer satisfaction, and management of resources and costs for the patient. The Case Manager serves as a patient advocate to ensure needs and communicated to the appropriate staff.

Essential Duties :

1. Makes contact with family or patient representative and performs introductory function and initiates discharge planning. Performs psychosocial assessment to determine pre-morbid history, human supports and available financial and community resources, cultural characteristics and interests, what the patient and family expectations for discharge.
2. In conjunction with the patient, family and treatment team arranges post hospital services such as home care or rehabilitation placement.
3. Promotes compliance with Medicare and payer source requirements. Responsible for contacting payer source to review accuracy of information, providing clinical update and discharge information as indicated by the payer source. Functions as liaison with payer representatives to manage financial resources, including verification of benefits for this and future settings Advocates with the payer on behalf of the patient to obtain needed services.
4. Documents payer source contact, including authorization, contacts, and days approved. Works in conjunction with admissions, billing, medical records, coding, and auditing to facilitate reimbursement.
5. Reviews medical documentation. Ensures completeness and accuracy of information, including appropriate admission orders.
6. Provides patient and family with overview of his/her rehabilitation program, and works in conjunction with the patient and treatment team to determine treatment goals and estimated length of time for completion.
7. Determines available financial resources and directs team planning to ensure conservation of funds and appropriate scope, intensity and duration of service delivery.
8. Works with the physician to determine and maintain appropriate patient status. Responsible for contacting the attending physician to request clarification of documentation or continued stay review questions. Responsible for informing Admissions and other departments of changes in patient status.
9. Reviews status, goals, and outcome barriers with the patient and treatment team and physician, monitors and facilitates progress towards goals. Ensures scope and intensity of services, financial coverage and alternative resources are appropriate to patient needs.
10. Reviews and monitors treatment plan and use of treatment resources, collaborates with treatment team and physician to determine cost effective means of obtaining an optimal patient outcome.

Requirements :

• Associate's Degree in Nursing required; Bachelor of Science in Nursing preferred from a nationally accredited nursing program
• 1-2 years clinical experience in an acute care hospital environment, surgical center, or rehabilitation setting required ; 2-4 preferred
• Registered Nurse license required; Certified Case Manager preferred

OrthoIndy is an Equal Opportunity Employer