- Assesses, plans, monitors, and coordinates plan of care from pre-admission to community re-entry through the implementation of case management standards and processes.
- Assesses the individual's personal and medical history, current status, diagnosis, prognosis, and the proposed treatment plan.
- Promotes and utilizes the appropriate level of care for the patient and refers to other facilities as needed.
- Adheres to contract agreements and specific criteria.
- Serves as a liaison with payor source points of contact to verify and guarantee coverage and identify items required to process the claim for service.
- Proactively communicates with payor source to explore coverage solutions (flex benefits, out of contract, etc.).
- Meets with patient, family, and IDT to facilitate "continuity of care".
- Implements utilization review process and continuously evaluates the appropriate level of care with the interdisciplinary team and payor, and patient/caregiver(s). Proactively collaborates with the health care team, payors, community agencies, providers and legal representatives to ensure continuity throughout the continuum.
- Serves as a liaison with the treatment team and the primary care physician, referring physician, medical director, patient/caregiver(s), and other parties as appropriate.
- Promotes effective communications among treatment team members, patient/caregiver(s), primary care physician, referring physician, medical director, and payor.
- Participates in care conferences, family conferences, etc. Uses the mechanism of early referral to promote and provide optimum care and cost containment.
- Participates in performance improvement evaluation processes with particular emphasis on results-oriented treatment.
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Case Manager - Greeley, CO, United States - PAM Health
Description
Case Manager PRN - RNHourly Rate - $48
The Case Manager is responsible for the interdisciplinary coordination of care for a designated patient population.
The Case Manager performs reviews of all inpatient admission records to ensure proper utilization of hospital resources and determination of admission for appropriate level team to facilitate achievement of desired financial and quality outcomes.
Admission Data Collection and Assessmentmaintaining knowledge of current community resources; and reviewing and being familiar with the managed care marketplace to determine managed care growth potential, opportunities, penetration, service trends, relationships, networks, etc.
Education and Training:
RN licensure in state where the hospital resides required.
PAM Health does not discriminate and does not permit discrimination, including, without limitation, bullying, abuse or harassment, on the basis of actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status, or based on association with another person on account of that person's actual or perceived race, color, religion, national origin, ancestry, age, gender, physical or mental disability, sexual orientation, gender identity or expression or HIV status.
Application window is anticipated to close a minimum of 7 days after posting %4508685% %%mednurse%%
