Registered Nurse (RN) - Case Management
Larkin Community Hospital
South Miami, FL

Case Manager (Full-Time)

Qualifications: * Experience * Previous C.M. Experience * Substantial clinical experience * Education * Bachelor's degree (required) * Masters (preferred) * Licensing * Foreign Medical Graduate or Registered Nurse (preferred) * CCM (Certified Case Manager) (preferred) * ACM (Accredited Case Manager) (preferred) * Bilingual (English/Spanish) (preferred) Responsibilities: * Performs and documents patient assessment within 24 hours of admission * Checks prior authorizations initiative by admitting * Knowledge navigating and using payer portals * Performs concurrent reviews * Contacting all HMO's on a daily basis and provides clinical information to obtain insurance authorization for the patient's admission and continued stay * Indicates the appropriate level of care and utilization of services needed * Establishes criteria for medically necessary services * Knowledgeable of Milliman Care and Interqual Guidelines * Develops a plan of care for patients from admission to discharge. * Promotes the most efficient and cost-effective use of services * Curtails the performance of inappropriate and/or duplicate services * Encourages standardization of medical practice patterns * Enhances the quality of healthcare * Performs concurrent reviews for patients to ensure that extended stays are medically justified and are documented in patient's medical records. * Calculates and manages the lengths of stay and continued-stay days for patients. * Evaluating the patient's condition and readiness for discharge planning * Develops discharge plans * Communicate and assist the physicians in the planning and coordination of patients discharge planning * Management of transfer procedures * Management of the guardianship process * Able to discuss and educate patient/family regarding discharge planning and resources available after discharge. Clearly specifies all the information discussed with the patient and/or family regarding the patient's discharge plan. * Participates in PI programs through the identification of opportunities for improvement, data collection, evaluation of findings, improving the process, applying knowledge and incorporates into practice * Scheduling Peer-to-Peer reviews with payors * Proactively identifying and resolving issues that could lead to denials Skills: * Familiarity with Medhost electronic medical records * Extensive medical knowledge * Self-driven (work and education) * Keeps knowledge up to date by reading literature and participating in outside continued education meetings, training, and conferences * Working knowledge of regulatory agencies * Excellent human relations and communication skills (verbal and written) to maintain good rapport and effective working relationships with medical staff, nursing staff, and other ancillary department staff throughout the hospital * Excellent organizational skills and attention to detail * Ability to convey care plan to physicians and the medical team * Proficient with Microsoft Office Suite or related software. * Integrity