The Case Manager acts as a resource to providers regarding discharge planning, medical record documentation, and all issues that may affect resource utilization and reimbursement. Responsibilities include:
- Concurrent review to include assessment of patient’s clinical, psychological, and financial needs to negotiate efficient movement of the patient throughout the continuum of care.
- Social Services clinical consults (WHC/Family Med) when needed in absence of Social Worker Case Manager or refer to covering Social Worker.
- Discharge planning for all patients.
- Swing Bed Rules and regulations as well as operations.
- Constant monitoring of utilization of hospital services.
- Utilization review phone calls.
- Responsible for department functions in the absence of the Case Management Director.
- Perform utilization management, discharge planning and resource management in accordance with state and federal guidelines and hospital policies and procedures.
- Act as a case management consultant to all disciplines.
Perform other duties as requested or assigned.
QUALIFICATIONS
EDUCATION:
- Participates in mandatory in-services and continuing education programs as mandated by policies and procedures, accreditation, or licensing agencies and as directed by the Department Director.
LICENSE / CERTIFICATION / REGISTRATION:
- Current Kansas RN license or ability to obtain licensure, per Kansas State Board of Nursing regulations.
- CARE Assessment Certification through KDADS.
- Certification in Case Management preferred but not required.
- BLS - Obtains RQI BLS certification within appropriate quarter (approximately within 3 months of hire), maintains quarterly RQI requirements.
EXPERIENCE:
- One year experience as a RN staff in a hospital setting preferred.
- Knowledge of community services preferred.
- Knowledge of MCG criteria preferred.
- Computer experience required.
