Job: RN Case Manager (full time)

Promotes and facilitates effective management of hospital resources from admission to discharge.

1.Concurrently assesses all patients within assigned population for: payment source; criteria compliance; resources; support systems; anticipated needs; expected length of stay; appropriate level of service; special / personal needs; and other relevant information.
2.With Social Worker, continuously monitors patient progress to discharge plan. 3. Complies with review requirements for Managed Contracts, Medicare, Medicaid, and Champus related to admission and continued stay approval. Adheres to Utilization Management Plan.
4.Communicates appropriately and timely with the interdisciplinary team and third party payers.
5.Prioritizes activities in assigned areas to focus on high risk, high cost, and problem prone areas.
6. Develops, collaborative relationships with patient business, nursing, physicians, social worker and patient/family to facilitate efficient movement through the continuum of care.
7.Monitors and evaluates data, fiscal outcomes, and other relevant information to develop and implement strategies for improvement.
8.Forwards identified quality and/or risk issues appropriately.
9.Maintains positive relationships with outside reviewers and other payer representatives.

Other Related Functions
1. Maintains confidentiality of data and information.
2.Serves as facilitators to physician and nursing staff.
3. Maintains records and documentation of work performed in an organized and easily retrievable fashion.
4.Reviews current literature on a regular basis; stays current on changes in policies and/or procedures; maintains reference materials and updates as required; keeps abreast of relevant reimbursement information.
5.Assumes responsibility as a self-directed professional for ongoing education, based on individual identified needs
6.Actively serves on committees and task forces to promote quality, cost-effective care for patient population.

Education/Training
Bachelor’s degree in nursing or related clinical field OR Graduate from approved school of nursing with four (4) additional years experience in case management, risk management, quality assurance, and/or utilization management required OR Advanced clinical degree required with 3 years acute care clinical experience

Licensure/Certification
Current RN license in the State of Florida required.

Experience
Three years acute care clinical experience required