Case Manager - RN

Job Description

Job Description

FUNCTIONS OF POSITION:

1. Performs admission, concurrent and focused reviews using severity of illness/intensity of service criteria to ensure effective utilization management.

2. Refers unjustified cases to physician advisor following hospital U.R. plan.

3. Collects and analyzes data to assure that quality and cost effectiveness issues are addressed for enhancement of patient care and Q.I./R.M./U.R. activities.

4. Maintains daily and monthly work log and/or abstracts on all reviews to ensure appropriateness of utilization review activities.

5. Prepares reports, graphs, and statistical data for reporting thru committee structures.

6. Collaborates with physicians, nurses, and other health care personnel to ensure effective utilization management.

7. Communicates with state PRO, insurance companies and other third party organizations to ensure appropriate utilization of resources.

QUALIFICATIONS:

EDUCATION: Graduate of accredited ADN or BSN program.

LICENSE: Possess current license by Missouri State Board of Nursing.

CREDENTIALS: Registered Nurse.

EXPERIENCE: Experience in case management preferred or two (2) years clinical experience in related field preferred.

SPECIAL:

PATIENT CONTACT: Must have the knowledge and skills necessary to provide care appropriate to the age of the patients served.

TYPING: Minimal

MACHINE OPERATION: Computer for entry or retrieval of data, 10 key calculator, copy machine, typewriter.

PHYSICAL:

STANDING: Minimal periods, but must be able to sit for long periods of time for reviewing of charts.

WALKING: Must be able to walk quickly to all areas of the hospital and occasionally to physician offices

LIFTING: Minimal - light loads (no more than 15 lbs)

VISUAL: Must have good acuity to review medical records, occurrence forms, computer screens, manuals, and other tools used in job performance

HEARING: Audio reception essential for effective understanding and communication with hospital staff and outside agencies

SPEAKING: Must have the ability to orally speak for effective communication with hospital staff and outside agencies