RN Care / Case Manager - Per Diem / As Needed - Days

Job Description

Job Description

Gaylord Specialty Healthcare is a health system dedicated exclusively to medical rehabilitation. We provide inpatient and outpatient care for people at every point in their journey from illness or injury to the most advanced state of recovery they can achieve. Our Mission : To enhance health, maximize function, and transform lives. Our values : Integrity, Compassion, Accountability, Respect and Excellence. These values guide us in providing quality patient care and transforming the lives of our patients.

JOB SUMMARY : The Care Manager coordinates all health care services required for an organized, multi-disciplinary team approach to management of designated patient populations; initiates discharge planning in a timely fashion, develops and revises individualized discharge plans as indicated by assessment and patient response to treatment; assesses quality, cost-efficient care to ensure patient’s plan of care promotes a safe and timely discharge; evaluates overall plan for effectiveness. Involves the patient and family in the formulation of goals; monitors appropriateness of admissions and continued stay; and provides the link between provider and payer organizations, physicians and the community in the transition of patient care through the health care system.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Assures and facilitates appropriate and efficient utilization of hospital services. Uses nationally recognized criteria in determining whether the patient meets medical necessity for LTACH level of care and takes appropriate action when variances are identified.
• Provides clinical information to managed care companies in a timely manner. Prevents denials through pro-active intervention with managed care reviewers, physicians and hospital staff. Administers notices of non-coverage to Medicare patients who do not meet medical necessity.
• Performs comprehensive assessments and reassessments of the patient’s condition and discharge planning needs including the psychosocial, physical, educational, cultural aspects, and social determinants of health. Works with the clinical team to develop and modify the care plan to meet the needs of the patient.
• Collaborates with other disciplines in patient evaluation and treatment and initiates referrals appropriately. Acts as the principal communicator to the patient, families and external case managers regarding insurance benefits / reimbursement, treatment plan, progress, length of stay and discharge plan.
• Initiates discharge planning in a timely fashion, develops and revises individualized discharge plans as indicated by assessment and patient response to treatment. Evaluates overall plan for effectiveness; involves the patient and family in formulation of goals.
• Meets monthly goals for length of stay management. Maintains compliance with The Important Message from Medicare, transfer notes, post-discharge phone calls, and other functions subject to audit.
• Portrays a professional demeanor reflective of the ICARE values to both internal and external stakeholders at all times.
• Demonstrates an understanding of level of care criteria and reimbursement factors for home care, rehabilitation, residential treatment and long term care in development of discharge plans. Seeks alternatives to facilitate discharge planning.
• Provides patients and families support and information about their current disability.
• Provides education and support to hospital staff regarding community resources, managed care issues, or payment / payer issues.
• Demonstrates an ability to be flexible, organized and functional under stressful situations. Utilizes critical thinking skills and sound judgment in priority setting and delegation.
• Practices autonomously, consistent with evidenced-based standards. Pursues personal and profession al growth and development.

QUALIFICATIONS :

WORK SCHEDULE : Per Diem / As Needed, weekdays

We Are An Equal Opportunity Employer – M / F / D / V