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General Summary

The Care Manager is accountable and responsible for coordinating the care and services of the assigned patient populations. The care manager promotes effective utilization and monitoring of health care resources and ensures appropriate placement across the continuum. The care manager assumes a leadership role with the Multidisciplinary Care Team (MDC) to achieve optimal clinical, financial and resource outcomes.

Responsibilities

Essential Duties and Responsibilities

Promotes effective utilization and monitoring of health care resources. Ensures appropriate placement across the continuum through medical necessity for admission, continued stay, or alternative treatment facilities, agencies, and/or resources.
Assumes a leadership role with the Multidisciplinary Care Team (MDC) and collaborates with other healthcare team members to achieve optimal clinical, financial and resource outcomes.
Contributes to the development of a goal directed plan of care that is prioritized and based on determined medical diagnosis, patient problems, co-morbidities, and expected patient outcomes. Evaluates effectiveness of care.
Completes, coordinates, and communicates the discharge plan in a timely manner with the patients, significant others, and providers of care based on age, social determinants of health needs, and patient's choice.
Follows regulatory guidelines to inform patients of their rights related to observation care, patient choice, and appeals in discharge. Communicates directly with patients, significant others, and providers of care during the denial process to include issuing denial letters and assisting in appealing hospital denials prior to and after the discharge of a patient.

Experience Requirements

Education

Graduate of an accredited School of Nursing or Social Work required, OR Equivalent years of experience in Case Management with at least a Bachelor’s degree in any field required. Bachelor’s in Nursing or Master’s in Social Work preferred.

Work Experience

At least 2 years of applicable clinical experience. Experience with utilization management, discharge planning, and third party payors preferred.

Certification/License

Missouri or Compact RN license, if applicable. Case Management certification preferred. BLS through American Heart Association required.

Mental/Physical Requirements

Considerable mental concentration required. Lifting up to 35 lbs., turning activities and nearly constant walking required. Standing, turning, carrying, pushing, pulling, stooping, crouching, twisting, and reaching.

Working Conditions

Frequent exposure to infectious disease and hostile persons at times. Frequent exposure to communicable disease via blood and other body fluids. Minimal physical discomfort.

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Jobs

RN - Care Manager | Full-Time 0.9 | M-F (12hr & 8hr shifts) | Every third weekend required

Summary

Responsibilities

Experience Requirements

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Jobs

RN - Care Manager | Full-Time 0.9 | M-F (12hr & 8hr shifts) | Every third weekend required

Summary

Responsibilities

Experience Requirements

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