Registered Nurse (RN), Case Manager at HCA Healthcare
Posted in Other 30+ days ago.
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Type: Part Time
Location: Round Rock, Texas
Job Code: 06240-58627
St. David s Round Rock Medical Center is part of St. David s HealthCare, one of the largest health systems in Texas, which was recognized with a Malcolm Baldrige National Quality Award in 2014. With 171 beds, the hospital s comprehensive services include advanced cardiac care at the Heart Hospital of Austin at St. David\'s Round Rock the first specialized cardiac facility in Williamson County with the only Hybrid Operating Room (OR) in the county; as well as emergency services in a 24-hour emergency department, including advanced trauma care with a Level II Trauma Center; St. David\'s Urgent Care Round Rock; and St. David\'s Emergency Center in Cedar Park. St. David s Round Rock Medical Center is also known for providing advanced orthopedic and robotic services, among other complex specialties. In 2016, the hospital received the Distinguished Hospital Award for Clinical Excellence from Healthgrades and also earned a national distinction for patient safety from The Leapfrog Group.
The Case Manager is responsible for the identification of high-risk patients, which require assessment and follow-through to accomplish the goal of high quality and cost effective patient outcomes.
ESSENTIAL JOB RESPONSIBILITIES
Financial Planning and Coordination
* Works cooperatively with Admissions Office and Business services to facilitate and ensure proper assignment of accommodation status for hospitalized patients.
* Monitors admissions to communicate patient information regarding policy coverage, limits required documentation and other relevant financial characteristics of coverage to appropriate staff and medical providers.
* Ensures required documentation and justification is provided to third party payers to obtain certification and rectification of hospital benefits.
* Serves as a liaison between interdisciplinary care team and funding sources, maintaining contact as required to report patient s status, progress, required treatments, and estimated length of stay.
* Works with the patient and family to identify financial resources available to them in the provision of necessary services either inpatient or post discharge.
* Provides routine reports on effective utilization of case management services related to cost containment and interventions resulting in a more positive outcome with patient family, funding source or other involved parties.
Treatment Planning and Coordination
* Participate in the assessment of patient clinical and psychosocial needs through review of patient information, personal contact with the patient and family and interdisciplinary care team communication.
* Serves as a liaison between members of the interdisciplinary care team, funding source, patient, family, and outside case managers to ensure treatment is met within quality standards and is in line with insurance/funding parameters.
* Schedules and coordinates patient care conferences as needed.
* Works cooperatively with members of interdisciplinary care team in the development, implementation, and review of the care management plan, in the coordination of patient service delivery, and in the concurrently clinical review process.
* Communicates routinely with the patient, family, interdisciplinary care team members, outside case managers and other appropriate parties with regard to the status of patient treatment plan and progress toward treatment goals, identification of concerns and/or problems, problem solving, and assisting the conflict resolution when necessary.
Discharge Planning and Continuity of Care
* Collaborates with interdisciplinary care team, patient and family in the assessment and coordination of discharge planning needs, delivery of post-discharge services and transition of the patient along the care continuum.
* Collaborate with the other care team members to assess the need for social service interventions for complex social issues.
* Documents discharge planning activities in the patient s chart.
* Reviews admissions for appropriateness of admission using Interqual standards.
* Provides for continued stay reviews for patients, which meet the case management criteria, reviewing for intensity of service and meeting of discharge screens using Interqual standards.
* Report s findings that do not meet Interqual standards to the attending physician, Case Management Director, Medical Director and the Utilization Committee.
* Tracks and trends cases not meeting Interqual standards.
* Assists with the denial and appeal process of medical necessity denials.
* Works cooperatively as a team with other Case Managers, Social Services, and interdisciplinary team members.
* Attends and participates in St David s Partnership committees and community committees.
Other Duties as Assigned
* Appropriately accesses secured rooms with medications storage containers in order to perform assigned job function, which does not include management of medications.
EDUCATION AND EXPERIENCE
Required: Graduate from an accredited school of professional nursing.
Preferred: Background in Utilization Review, Resource Management, and/or Case Management. Critical thinking skills and problem solving skills with excellent communication skills both written and verbal.
LICENSES AND CERTIFICATES
Required: Licensed in the state of Texas as RN OR hold eligible compact license to practice as an RN in the state of Texas. Registered Nurse in the State of Texas. Obtain BLS within 3 months of employment.
Preferred: Utilization Review/Case Management experience, ACM, BLS
Reports to: Director of Case Management
Positions supervised: None
Associate's Degree/College Diploma
Last Edited: 03/06/2018