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    Case Manager, RN PRN Days - Sunnyvale, TX, United States - Baylor Scott & White Medical Center - Sunnyvale

    Baylor Scott & White Medical Center - Sunnyvale
    Baylor Scott & White Medical Center - Sunnyvale Sunnyvale, TX, United States

    1 week ago

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    Description
    This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units.

    Discharge planning is coordinated with physicians, nursing, patient and significant others who have an ongoing caring relationship with the patient.

    Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.

    Responsible for performing assessments on Medicare, Medicaid, Private Pay, Commercial insured and high-risk patients to determine discharge planning needs, always documents assessments.

    (Able to communicate with physician regarding Medical necessity of the patient. Assists the physician to facilitate optimal documentation to support level of care.
    Is knowledgeable of criteria for Medicare, Medicaid, Commercial and private insurance coverage.
    Communicates daily with admissions personnel regarding admissions and discharges to various units, when applicable.
    Interacts professionally with patient/family and involves patient/family in the formation of the plan of care if necessary.
    Is knowledgeable of patient's financial status, diagnosis and discharge needs.
    Acts on performance improvement issues identified during CQI meetings.

    Collaborates with the Business Office Manager, insurance verification, Clinical Documentation Specialist and Authorization Coordinator to facilitate obtaining authorizations for appropriate level of care.

    Demonstrates an ability to be flexible, organized and function under stressful situations.
    Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
    Documentation meets current standards and policies.

    Maintains regulatory requirements, including all state, federal and JCAHO regulations related to the Imaging Services Department and, as appropriate, to the facility.

    Works at maintaining, a good rapport and a cooperative working relationship with physicians, departments and staff.
    Ensures compliance with policies and procedures regarding department operations, fire, and safety and infection control.
    Effectively and consistently communicates administrative directives to personnel and encourages interactive departmental meetings and discussions.
    Complies with all organizational policies regarding ethical business practices.

    Attends at least 8 staff meetings annually, is responsible for information presented at monthly staff meetings that he/she is unable to attend.


    REGULATORY REQUIREMENTS
    Medical Surgical nursing within past 3 -5 years
    Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
    Experience in providing patient care.


    LANGUAGE SKILLS
    Ability to read and communicate effectively in English.
    Additional languages preferred.

    Basic computer knowledge


    Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.

    Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.


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