- Develops and implements a patient specific, safe and timely discharge plan.
- Performs verification of utilization criteria reviews.
- Builds relationships and coordinate with payor sources to assure proper reimbursement for hospital provided services, promote costs attentive care via focus on resource management within the plan of care.
- Demonstrates compliance with facility-wide Utilization Management policies and procedures.
- Coordinates UR compliance with Quality Management to assure all licensure and accrediting requirements are fulfilled.
- Maintains fiscal responsibilities. Assures the department is identifying and negotiating the fullest possible reimbursement to maximize insurance benefit coverage for the patient. Reviews insurance verification forms to minimize risk.
- Facilitates multi-disciplinary team meetings including physicians, nurses, respiratory therapists and rehabilitation therapists.
- Bilingual
- Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per state guidelines
- Previous RN/LPN/RT/SW/CM experience in an inpatient hospital setting dealing with critical care/acute care patients. (example: ICU, step-down, med surg, vents)
- Adequate experience in an acute medical case management setting and confidence to manage and direct a plan of care for chronically critically ill populations
- Specific experience in Care Management and Discharge Planning is preferred.
- Working knowledge of the insurance industry and government reimbursement.
- Availability to work a minimum of 2 shifts per month on an "as needed" basis - shifts would be scheduled on weekdays, from appoximately 8a.m.-5p.m.
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Case Manager - Miami, United States - Select Specialty Hospital
Description
Overview
Critical Illness Recovery Hospital
Case Manager (PRN)
Requires a current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW (potential license per state guidelines).
And
Previous experience in critical care setting required.
Previous discharge planning experience highly preferred.
SHIFT:
*Availability to work a minimum of 2 shifts per month on an "as needed" basis - shifts would be scheduled on weekdays, from appoximately 8a.m.-5p.m.*
At Select Specialty Hospitals and Regency Hospitals, a division of Select Medical, we care for chronically and critically ill or post-ICU patients who require extended hospital care. Select Medical employs over 48,000 people across the country and provides quality care to approximately 70,000 patients each and every day across our four divisions.
Our mission is to provide an exceptional patient care experience that promotes healing and recovery in a compassionate environment. Each employee plays a vital role in doing that by living our cultural behaviors - celebrating success, owning the future, being patient-centered, creating change, thinking first and building trust.
Are you resourceful in overcoming obstacles? Are you a results-oriented team player? If you answered 'yes', consider an opportunity with us
Responsibilities
We are looking for valued employees who will be Champions of the Select Medical Way, which includes putting the patient first, helping to improve quality of life for the community in which you live and work, continuing to develop and explore new ideas, providing high-quality care and doing well by doing what is right.
The Case Manager is responsible for utilization reviews and resource management, discharge planning, treatment plan management and financial management, while also completing medical record documentation. You will report directly to the Director of Case Management and provide social work services, as necessary, per state guidelines.
Qualifications
How you will be successful in this environment:
We are seeking results-driven team players. Qualified candidates must be passionate about providing superior quality in all that they do.
Minimum requirements:
Preferred qualifications that will make you successful:
Additional Data
Select Medical strives to provide our employees with work-life balance, as we understand that happy employees have both fulfilling careers and fulfilling lives beyond our doors.
We'd love for you to join the team
Select Medical is committed to having a workforce that reflects diversity at all levels and is an equal opportunity employer. Qualified applicants are considered for employment, and employees are treated during employment without regard to race, color, religion, national origin, citizenship, age, sex, sexual orientation, gender identity, marital status, ancestry, physical or mental disability, veteran status, or any other characteristic protected under applicable law.
