Summary:

The Care Manager effectively communicates with internal and external clinical professionals. Efficiently organizes the care of the patients and assess the homes for needs and makes appropriate arrangements. Critically thinks for appropriateness of care provided the patients within the scope of care of the healthcare center. Effectively multitasks the workday, accurately inputs computer info, and successfully accomplishes difficult tasks as assigned.

Responsibilities:

• Maintains consistency with Administrative and Departmental policies with appropriate behavior, dress, attitude, attendance, confidentiality, professionalism, and reliability.
• Identify, evaluate and provide case management services for patients, and analyze information supplied by physicians (or other clinical staff) to make timely review determinations, based on appropriate criteria and standards.
• Coordinate certifications of services with the appropriate payor.
• Identify and refer over/under utilization issues and refer appropriate cases to VP Medical Affairs.
• Initiate timely and appropriate Discharge Planning.
• Collect and analyze data to assure quality outcomes.
• Serves as liaison for patient, family and physician to assist in communication.
• Reinforces and interacts with patients, physicians and families across the continuum to include post-acute services.
• Assures timely medical record documentation to coordinate appropriate clinical documentation for all services 

Requirements:

Experience

• Minimum of five years recent clinical experience as an RN. Negotiating skills which support the ability to interact with physicians, nursing staff, discharge planners, and payers. 
• Excellent verbal and written communication skills
• Knowledge of clinical protocol, normative data and health benefit plans, particularly coverage and limitation clauses. 
• Ability to manage several projects and cases simultaneously. 
• Knowledge of community resources.

Education

• Bachelor’s Degree in Nursing, preferred

Licenses, Registrations, or Certifications

• Current Registered Nurse License

Work Type:

Full Time

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