RN Case Manager/UR

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1\) Ensure that appropriate patients are admitted to the skilled care

program, which includes the following functions:\

• Work with the UR, SW, and Department Director to identify potential
  
  

candidates for the skilled care program.\

• Ensure that the patient meets qualifications for skilled care.\
• Facilitate issuance of the hospital issued notice of non-coverage
  
  

(HINN).\

• Discuss with the patient/family change in level of care from acute to
  
  

skilled care status.\

• Ensure that physician orders and certification for skilled care
  
  

services are obtained in a timely manner.

2\) Maintain patient census log for skilled care program, which includes

records of all patients screened and admitted to the\

skilled care program.\

• Facilitate assessment of all patients admitted to the skilled care
  
  

program.\

• Complete the Resident Assessment Instrument Minimum Data Set
  
  

(RAI-MDS; also called MDS) according to Medicare\

schedule for Skilled Care.\

• Supervise and coordinate the Activities Program for Skilled
  
  

Care/Swing Bed patients.\

• Perform the Essential Functions of the Nursing Activity Clerk.\
• Meet CMS requirements for initiating, updating, and maintaining the
  
  

care plan.\

• Maintain knowledge about state-required assessments, including
  
  

requirements on completion of the MDS, according to\

defined coding to ensure proper reimbursement for care.\

• Assist the Discharge Planning Team in reviewing patient goals; revise
  
  

and complete goals as appropriate.\

• Facilitate interdisciplinary care for patients in the Skilled Care
  
  

Program.\

• Attend and participate in Discharge Planning Team meetings.\
• Document patient information in the Electronic Medical Record.\
• Participate in quality assurance, assessment and improvement
  
  

activities.\

• Maintain current knowledge of the Skilled Care Program and
  
  

regulations that apply to patient care, reimbursement, and\

surveys. Utilize and attend skilled care continuing education when

possible.\

• Serve as a liaison between patients, families, physicians,
  
  

management and staff. Communicate regularly with director,\

staff and physicians.\

• Communicate the Resource Utilization Group (RUG) category and other
  
  

clinical information needed to process claims. A.)\

Maintain log of RUG categories and services that are excluded from

consolidated billing. B) Submit information to the business\

office for timely billing of the skilled care claim.\

• Involve patient and families in the plan of care by discussing that
  
  

plan with them. Invite patients and/or families to care\

planning meetings as appropriate.\

• Review all care plans and goals with patients or families that did
  
  

not attend care plan meeting.\

• Ensure patient information is shared with appropriate disciplines.\
• Collaborate with and assist the Social Work department in the
  
  

Discharge Planning Process. Ensure the discharge plan is\

initiated and is revised according to patient progress; verify the

patient/family is informed of discharge plans; verify postdischarge care

needs are identified and addressed.\

• Serve as a resource for the patient, family and physician. Meet with
  
  

patient, family and physicians as needed to address\

issues that arise.\

• Collaborate with and assist Utilization Review Nurses.\
• Performs other duties as assigned.
  
  

1\. Perform the Essential Functions of Ward Clerk.\

• Perform the Essential Functions of Staff Registered Nurse.\
  
  

\

Knowledge, Skills, and Abilities:\

Will be orientated to and maintain competence in working with adult and

geriatric patients. Competence at the beginning of employment\

will be measured through observation during orientation, math and

medication administration testing, and review of documentation.\

Ongoing competence will be measured through observation of clinica

practice, observation for performance evaluation, competency inservice

and testing, and math and medication administration testing. See

attached sheet for other initial and ongoing competencerequired by each

department.