RN Case Manager

Overview

Provides discharge planning and utilization review services in compliance with patients discharge planning needs and the hospital’s utilization review program. Coordinates and manages the facilities Swing Bed program while fostering provider and ocmmunity relationships to increase referrals and census.   

SAFETY SENSITIVE POSITION:

This position is a designated as “Safety Sensitive Position” under Act 593 of the State of Arkansas. An employee who is under the influence of Marijuana constitutes a threat to patients/customers which Conway Regional is responsible for in providing and supporting the delivery health care related services. 

Qualifications

• Registered Nurse, licensed to practice in Arkansas OR
• At least one-year experience int he area of case management/utilization review, preferred.  
• Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) certifications are required
• Excellent written and verbal communication skills to include computer knowledge

Responsibilities

Case Manager:

Serves as a Liason between patients, their families, physicians, and other health care personnel

Responsible for Discharge Planning of Acute Care Patients

Conducts Discharge Planning Meetings per Arkansas Department of Health (ADH) Rules and Regulations

Collaborates with Utilization review of all acute care patient services.

Participates in appropriate department/hospital committees and meetings.

Investigates and resolves complaints or refers problems to appropriate Manager/Director.

Maintains positive relationships with other Case Managers, and contacts at area facilities.

Develops and implements quality improvement data.  Reports data to leadership and quality.

Obtains and maintains medical records in conformance  with Medical Information policies.

Communicates with co-workers in a manner that is conducive to positive and effective working relationships.  Demonstrates respect, honesty and integrity when working with other service providers.

Demonstrates compliance with all relevant hospital, state and feeral requirements related to maintenance of confidentiality of persons, data and information systems.

Responsible for analysis of patient information for determination of necessity of admission or continuation of stay.

Review for medical necessity of admisiion on the first working day after admission using approved review criteria.

Reviews inpatient procedures to determine appropriate utilization and acuity level.  Reviews potential for outpatient setting or swing bed utilization.

Reviews all patients for medical necessity of continued stay, or before the next review date, using approved review criteria.

Performs retroactive reviews, as necessary, and responds to the appropriate review agency or third-party payor. 

Researches denials issued by review agencies and third-party payors and responds within the specified time frams for appeal.

Participates in weekend rotation of call for nursing leadership.

Other duties and responsibilities as assigned by management. 

Swing Bed Coordinator:

Responsible for coordinating and managing the facility's Swing Bed Program.

Coordinates the admission and referral process for Swing Bed patients from initial referral through admission and discharge.

Serve as the primary point of contact for hospitals, discharge planners, case managers, physicians, patients, and familities regarding Swing Bed referrals.

Review referrals and gather required clinical, demographic, insurance, and other admission information.

Coordinate with nursing, therapy, dietary, billing, and other departments to facilitate timely admissions.

Monitor referral status and follow up promptly on pending referrals and potential admissions.

Assist with insurance verification, prior authorization, and other payer requirements as applicable.

Maintain accurate and timely documentation related to referrals, admission, and patient transitions. 

Track Swing Bed census, refererals, admissions, discharges, and referral outcomes.  

Identify barriers to admission and communicate them to appropriate members of the care team.

Maintain compliance with applicable federal and state regulations, facility policies, and Swing Bed requirements.  

Protect patient confidentiality and follow HIPAA requirements at all times.

Develop and maintain professional relationships with hospitals, physicians, physician offices, discharge planners, case managers, social workers, home health agencies, hospice providers, and other referral sources.

Conduct regular outreach to existing and prospective referral partners.