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Description:
•Responsibilities: Extended Care Coordinator, provide comprehensive case management for patient at skilled nursing facilities including coordination with SNF team members, nursing, rehab, discharge planning, dietary, admission, DON, administrator and KP physicians.
•Float department (if needed): Special Needs Department (SNP), provide telephonic case management
•Certificates required: RN license
The RN Case Manager Assistant is responsible to conduct medical necessity screening and work collaboratively with the interdisciplinary team to provide care coordination for patients under the direction of a Registered Nurse and in compliance with evidence-based practice and regulatory requirements. This position complies with the scope of services defined by the Registered Nurse RN state licensure requirements.
This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention, Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care, Compliance with state and federal regulatory requirements, TJC accreditation standards and policy Education provided to physicians, patients, families and caregivers, and other duties assigned. Essential Responsibilities: The individual's responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review b) care coordination, c) implementation of the transition plan based on RN Case Manager and/or Social Worker (SW) assessment(s), d) communication with interdisciplinary team during patient care conferences, e) management of concurrent disputes, f ) communication with patients and families regarding the plan of care established by RN, SW and Physician, g) collaboration with physicians, office staff and ancillary departments, h) clear, complete and concise documentation in electronic system, i) maintenance of accurate patient demographic and insurance information, j) identification and documentation of potentially avoidable days, k) identification and reporting of over and underutilization, l) and other duties as assigned Utilization Management: Assures the patient is in the appropriate status and level of care based on Medical Necessity process and submits for Secondary Physician review per Kaiser policy. Ensures timely communication of clinical data to various payers to support admission, level of care, length of stay and authorization for post-acute services. Advocates for the patient and hospital with payers to secure appropriate payment for services rendered. Completion of clinical reviews. Promotes prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes. Identifies and documents Avoidable Days using the data to address opportunities for improvement. Prevents denials and disputes by communicating with payers and documenting relevant information. Coordinates clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) supported by evidence-based practice, internal and external requirements. Identifying appropriate level of care needs. Assisting with patient transition to the appropriate level of care. Order clarification admission status and patient classification.
Skills:
case management, acute care, Registered Nurse, excel data entry
Top Skills Details:
case management,acute care,Registered Nurse
Additional Skills & Qualifications:
Registered Nurse - RN
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Other
$91k-109k (estimate)
07/01/2023
05/10/2024
The job skills required for RN Case Manager include Case Management, Coordination, Health Care, Planning, Acute Care, Discharge Planning, etc. Having related job skills and expertise will give you an advantage when applying to be a RN Case Manager. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by RN Case Manager. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for RN Case Manager positions, which can be used as a reference in future career path planning. As a RN Case Manager, it can be promoted into senior positions as a Case Management Director that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary RN Case Manager. You can explore the career advancement for a RN Case Manager below and select your interested title to get hiring information.
If you are interested in becoming a RN Case Manager, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a RN Case Manager for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on RN Case Manager job description and responsibilities
Case Managers act as patient advocates and make sure the needs of the patient are met effectively and efficiently.
12/13/2021: Burlington, VT
Case Managers generally work with patients that have chronic health conditions such as diabetes, heart disease, seizure disorders, and COPD.
02/20/2022: Altus, OK
The Case Manager RN reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation s
01/12/2022: Rochester, NY
Prepares all required documentation of case work activities as appropriate.
01/28/2022: Lexington, KY
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on RN Case Manager jobs
Before becoming an RN case manager, a nurse would be expected to earn some clinical experience.
01/18/2022: Concord, NH
Graduate from an Accredited Nursing Program.
01/10/2022: Albany, NY
Gain Experience Working as a Nurse.
01/10/2022: Worcester, MA
They should be familiar with emerging professional and technical aspects and have RN case management experience.
01/27/2022: Santa Rosa, CA
Step 3: View the best colleges and universities for RN Case Manager.