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Case Manager, Resource Management (FT)

Southeast Georgia Health System - Brunswick, Georgia
Friday, March 15, 2019

Southeast Georgia Health System has an opportunity for a Case Manager to join our Resource Management team!

The Case Manager coordinates the care and services for patient populations through the acute care episode, across the continuum. Works collaboratively with interdisciplinary teams, both internal and external to the Health System, to improve patient care through effective utilization and monitoring of healthcare resources.

The Case Manager performs the following essential duties:

* Facilitates timely and appropriate patient care delivery and hospital resource utilization by performing: admission and concurrent review of all patients for medical necessity and proper admission status, utilizing McKesson InterQual UR screening software; Providing clinical information to third-party payers as appropriate, to include a maintenance time table for follow-up clinical to avoid denial of patient charges. Facilitating disposition of medical necessity review issues per policy and/or procedure. Assessing, planning, communicating, educating, initiating and completing transition planning as ordered by a physician or requested by the patient and/or family member. Documents Case Management activity in the medical record as appropriate.
* Oversees process/procedure of notification for Medicare and Medicare Managed Care beneficiary’s rights per CMS regulations inclusive of but not limited to: Notification of Hospital Discharge Appeal Rights, Condition Code 44, Election of Lifetime Reserve Days, Medicare Outpatient Observation Notice, and Hospital Issued Notice of Non-coverage.
* Achieves communication and coordination between members of the health care team involving the patient/designee in the decision-making process in order to minimize fragmentation in services. Communicates effectively with patients, families, visitors, co-workers, physicians and external providers, treating all with dignity and respect. Ability to compassionately perform during a crisis and unpleasant situations.
* Presents to patient and/or designee a list of provider choices for use in transition planning, ensuring that federal regulations are met regarding patient choice and the complete and accurate documentation of such.
* Assumes a leadership role to achieve desired clinical, financial, and resource outcomes. Actively participates in compliance with The Joint Commission standards, processing the AR cycle, fiscal stability and length of stay efforts of the Health System.
* Respects each patient's right to privacy and confidentiality by complying with HIPAA regulations/law.
* Ability to assess and assist patients with medical, psychological, financial and social needs. Advocate for difficult to place patients which include: abandoned elderly, long term ventilator patients, under/uninsured patients, and patients with extensive medical, social and/or psychological needs.

The ideal Case Manager candidate should posses the following minimal qualifications:

* Graduate of RN or LPN Diploma/Certificate, or Associate’s or Bachelor’s degree in Nursing.
* Five years acute care clinical experience preferred.
* Registered Nurse or Licensed Practical Nurse in the state of Georgia
* Ability to work with diverse populations; appropriate computer, organizational and communication skills required. Skills needed include excellent written/verbal communication skills, critical thinking skills, strong clinical assessment skills, creative problem solving, and the ability to plan and organize effectively.
* Must be self-directed, and have the ability to tolerate frequent interruptions and a demanding work load. Knowledge of funding sources, health care services, human behavior dynamics, the health care delivery and financing systems, and clinical standards and outcomes is preferred.

Service Excellence: All team members of Southeast Georgia Health System will promote service excellence by developing and maintaining positive relationships with customers, other team members, and the medical staff and will ensure the highest quality of care by performing their responsibilities according to the highest professional standards.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, or national origin. EOE/AA: M/F/D/V

Job Type: 1.0
Hours: Days
Location: Brunswick, GA - Georgia

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