- Monitors individual cases according to set criteria, length of stay, and patient care guidelines
- Ensures patients meet the level of care criteria and issues care denial letters when necessary
- Intervenes as needed to ensure timely care provision and resource utilization
- Acts as a source of information for physicians and nurses regarding continued stay criteria and medical necessity
- Tracks patient outcomes to assess clinical and financial efficiency
- Verifies services provided against patient benefits and liaises with physicians and third-party payers for proper reimbursement
- Collaborates with the patient care team to transition the population effectively by planning for ongoing care or moving to a different level of care to address all patient needs
- Evaluates social and emotional factors influencing patients' health status and makes relevant referrals
- Participates in the Discharge Planning Team and initiates discharge planning early in the treatment process based on the care plan and initial assessment needs
- Contributes to the SWB Team and facilitates patient eligibility screening
- Provides SWB details to patients and families as necessary
- Monitors patient progress for timely discharge to the suitable setting
- Assists with MDS as needed for billing and reimbursement purposes
- Identifies and reports physician practice patterns and resource usage
- Maintains precise records of reviews and discharge planning activities
- Highlights lack of medical necessity for admissions, observation versus admission appropriateness, and length of stay trends
- Establishes positive working relationships and communication with physicians, professional staff, and other healthcare team members regarding continued stay issues and medical necessity documentation
- Collaborates with the business office for accurate billing and statistical data
- Coordinates with social worker to identify and arrange resources, both internal and external, to best meet patient requirements
- Capable of communicating effectively with various age groups on discharge needs
- Participates in educational sessions with physician office staff when requested
- Currently holds a valid Alabama Registered Nurse license and is in good standing with the State Board of Nursing
- Minimum of 5 years of diverse clinical experience
- Able to interpret medical record documentation
- Proficient in PC operation
- Strong organizational skills and proactive approach
- Excellent verbal and written communication abilities
- Maintains current ACLS and BLS certifications
- Licenses: Registered Nurse Certification and Licensed Social Worker
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Case Manager - Tupelo, United States - North Mississippi Health Services
Description
At North Mississippi Health Services, our main goal is to consistently enhance the well-being of the individuals in our area. Our aim is to offer top-notch care and health services that focus on patients and families in the United States. We firmly believe that to achieve our objectives, we must bring in exceptional individuals who can establish strong connections with our patients and families.
We take great pride in recognizing and appreciating all the unique aspects that define you - your skills, your viewpoints, and your interests. At North Mississippi Health Services, we are dedicated to aligning your enthusiasm with a meaningful purpose. When you become part of our team, you experience the true essence of connectivity.
Job Description Review Activities:
Clinical Practice:
Swing Bed Responsibilities:
Reports:
Customer Service:
Job Knowledge:
Requirements:
The following are prerequisites in addition to those stated above.
