HCA, Hospital Corporation of America RN, Registered Nurse - Case Manager in Round Rock, Texas

St. David's Round Rock Medical Center:

Located in Round Rock Texas (Austin Texas area)

Case Management

Position Description: 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.

1.0 FINANCIAL PLANNING AND COORDINATION 1.1 Works cooperatively with Admissions Office and Business services to facilitate and ensure proper assignment of accommodation status for hospitalized patients. 1.2 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.
1.3 Ensures required documentation and justification is provided to third party payers to obtain certification and rectification of hospital benefits. 1.4 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. 1.5 Works with the patient and family to identify financial resources available to them in the provision of necessary services either inpatient or post discharge. 1.6 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.

2.0 TREATMENT PLANNING AND COORDINATION 2.1 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 conferences. (Grand Rounds) 2.2 Serves as a liason 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. 2.3 Schedules and coordinates patient care conferences as needed. 2.4 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. 2.5 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.

3.0 DISCHARGE PLANNING AND CONTINUITY OF CARE 3.1 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. 3.2 Collaborate with the other care team members to assess the need for social service interventions for complex social issues. 3.3 Documents discharge planning activities in the patient's chart.

4.0 UTILIZATION MANAGEMENT 4.1 Reviews admissions for appropriate ness of admission using Interqual standards. 4.2 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. 4.3 Reports findings that do not meet Interqual standards to the attending physician, Quality Manager and/or the Medical Director. 4.4 Tracks and trends cases not meeting Interqual standards. 4.5 Assists with the denial and appeal process of medical necessity denials.

5.0 GENERAL DUTIES 5.1 Works cooperatively as a team with other Case Managers, Social Services, and interdisciplinary team members. 5.2 Attends and participates in St David's Partnership committees and community committees. 5.3 Coordinates Grand Rounds for the interdisciplinary team. 5.4 Performs other duties as required.

Knowledge and Skills: Ability to communicate effectively, read and comprehends complex clinical and financial data; organize, prioritize and manage time efficiently. Utilizes computer keyboard extensively to obtain and transmit patient, financial, medical and and psychosocial information of a confidential nature. Operates printer to obtain computer-generated information. Utilizes telephone and FAX machine. Must be able to communicate effectively with a wide range of hospital personnel, physicians, patients/family members and representatives of outside agencies. Ability to work with patients of adolescents, adult and geriatric age. Must be able to communicate both verbally and in writing. Knowledge of community resources and continuum of care options. Ability to use Interqual standards for appropriateness of admissions continued stays and discharge. Knowledge of Millman and Robert's Length of Stay guidelines. Understanding of Managed Care, Medicare and Medicaid. Ability to integrate clinical, social and financial assessments into a patient care plan.

Education and Experience: Required: Ten years of nursing experience.
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 Certifications: Required: Registered Nurse in the State of Texas. Preferred: Certification in Utilization Management, Case Management or Quality

Title: RN, Registered Nurse - Case Manager

Location: Texas-Round Rock-Round Rock Medical Center

Requisition ID: 06240-54941