Case Manager - Pond 4- per diem

• 1. Initiates Discharge Planning By Screening The Patient For Continuing Care Needs.; Assesses Patients With Identified Needs; Develops And Implements A Discharge Plan To Address Patient?S Continuing Care Needs In Collaboration With The Health Care Team, Approval Of The Attending Physician, And Acceptance By The Patient/Family; Monitors Effectiveness Of The Discharge Plan.
  
• 2. Using Established Criteria, Reviews The Following:
• 3. Appropriateness Of Patient?S Admission.
• 4. Need For Continued Stay.
• 5. Information Needed For Discharge.
  
• 6. Completes Saga Applications On All Uninsured Patients.
  
• 7. Collects Data On Variances From Quality Screening Criteria And Forwards This Data To The Cluster Director.
  
• 8. Monitors The Process Of Acute Care For Any Unexpected (Variant) Response To The Clinical Setting. Makes Timely And Appropriate Referrals That Will Coordinate Intervention To Correct The Variant Response.
  
• 9. Responds To Third-Party Requests For Concurrent Clinical Information.
  
• 10. Communicates To Risk Management All Incidents That Are Potentially Compensable Events.
  
• 11. Issues Letter Of Denial And Reinstatement Within Regulatory Timeframe.
  
• 12. Coordinates Activities To Ensure Patient?S Appeal Right Under The Discharge Appeals Program. Initiates Appeal Process For Insurance Denials As Appropriate.
  
• 13. Discusses Estimated Length Of Stay, Treatment, And Discharge Plan With The Attending Physician, And Treatment Team, As Indicated.
  
• 14. On Daily Basis, Reviews The Patient?S Plan Of Care, And Focuses On The Need For Continued Hospitalization.
• 15. Coordinates And Leads The Staff As Indicated To Ensure The Following:
• 16. Completion And Reporting Of Diagnostic Testing.
• 17. Completion Of Treatment Appropriate For The Acute Episode Of Illness.
• 18. Modifications Of The Plan To Meet The Continuing Care Needs Of The Patient.
• 19. Communication Of Relevant Issues And Third-Party Payer Information To The Team.
• 20. Assignment Of The Appropriate Level Of Care.
  
• 21. Consults With Physicians, Nursing Staff And Staff In Ancillary Departments And Coordinates The Elimination Of Barriers To Efficient Delivery Of Care In The Appropriate Setting.
  
• 22. Ensures Timely Completion Of All Discharge, Transfer, And Referral Forms.
  
• 23. Maintains Clinical Competency And Current Knowledge Of Regulatory And Payer Requirements To Perform Job Responsibilities.
  
• 24. Maintains Current And Working Knowledge Of Case Management, Utilization Management, Discharge Planning, As Specified By Federal, State, Private Insurance Guidelines.
  
• 25. Meets Performance Expectations For Customer Service, Teamwork, Resource Utilization, And Staff And Self Development As Outlined In Performance Review.
  
• 26. Performs Other Duties As Assigned Or Directed To Ensure Smooth Operation Of The Department/Unit.
  

EDUCATION

Registered Nurse With Current Ct License. Bachelors Degree In Health Care Related Field Required. Masters Degree Preferred Or Equivalent Experience.

EXPERIENCE

Facilitation Of Health Services Across Level Of Care; Negotiation For Benefits With The Managed Care Environment; Monitoring Appropriateness Of Healthcare Setting; Auditing And Analysis Of Health Care Delivery Practices.

LICENSURE

Registered Nurse With Current Ct License. BLS Required.

SPECIAL SKILLS

Certification Or Eligible For Certification In Case Management A Benefit. Strong Leadership, Communication, And Computer Skills Desired.