RN - Case Manager

RN II - Case Management/Utilization Review

Provides care to the community since 1959. Includes a 162-bed acute care facility with a county-designated trauma center. Assesses appropriateness of admission status and level of care using InterQual criteria. Provides discharge planning services, coordinating with patients, families, and community agencies. Collaborates with medical staff to ensure appropriate utilization of hospital resources. Expedites high-quality patient care. Requires ten-hour shifts with occasional weekends in rotation. Assists in making admission decisions regarding observation or inpatient status. Reviews patient charts on the day of admission or the first day after admission. Completes Advance Directive forms as needed. Identifies needs for follow-up case management and documents opportunities for intervention. Coordinates team or family conferences to ensure timely responses to needs. Proactively assists in the development of patient care and teaching plans. Completes InterQual reviews and reviews care and progress on assigned patients. Documents progress in the computer system and patient chart. Moves patients through the system based on the level of need. Issues necessary letters and refers cases that do not meet criteria to the appropriate advisor. Obtains optimal coverage for patients by providing appropriate medical information to insurers. Acts as a liaison between payers, medical staff, patients, and families. Collaborates with team members to maximize reimbursement through essential documentation. Documents authorizations and denials in the computer system. Engages in proactive discussions with medical staff regarding appropriate inpatient testing. Anticipates discharge needs and makes suggestions for referrals linking the patient and family to resources. Ensures patients are medically stable for discharge and prepared educationally and emotionally. Coordinates timely transfers of patients to other facilities. Provides accurate documentation in the patient record and hospital computer system. Performs other job-related duties as assigned. Commits to the safety and well-being of associates and patients. Requires all associates to receive all required vaccinations as a condition of employment.