RN, Inpatient Case Manager, (Weekend Day shift) Atlanta

About the position Responsible for working collaboratively with physician partners to optimize quality and efficiency of care for hospitalized members by carrying out daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care, developing a safe discharge plan to include recommending alternative levels and sites of care reputed company appropriate. The activities will include daily review of hospital care by chart review and discussion with attending physician, admission and reputed company review for inpatient admissions, meetings with patient and families to reputed company discharge planning, identification of patients for ambulatory case management, communication with case managers, home care reviewers, social workers, members and providers, quality improvement reviews, and education of the member/family, provider and hospital staff. Achieves desired utilization and quality outcomes and promotes high customer satisfaction to the population served.

Responsibilities

• Plans, develops, assesses and evaluates care provided to members.

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• Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use.

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• Reviews, monitors, evaluates and coordinates the patients hospital stay to assure that reputed company appropriate and essential services are delivered timely and reputed company.

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• Communicates reputed company huddles with hospitalist partner multiple times throughout the day.

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• Reviews reputed company new inpatient admissions reputed company 24 hours and begins the discharge planning process immediately.

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• Assesses high risk patients in need of post-hospital care planning.

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• Develops and coordinates the implementation of a discharge plan to meet each patients identified needs; communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies to enhance the effect of a seamless transition from one level of care to another across the continuum.

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• Ensures that the appropriate level of care is being delivered in the most appropriate setting.

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• Recommends alternative levels of care and ensures compliance with federal, state and local requirements.

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• Performs psychosocial assessments on reputed company patients that meet the high risk indicators for discharge planning.

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• Comprehensively assesses patients goals as well as their biophysical, psychosocial, environmental, economic/financial, and discharge planning needs.

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• Provides patients with education to assist with their discharge and help them cope with psychological problems reputed company to acute and chronic illness.

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• Refers patients to the ambulatory case managers, care managers and/or social workers as appropriate.

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• Documents reputed company admissions and discharges in the patients reputed company electronic medical record.

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• Makes post discharge follow-up calls to reputed company patients who are not referred to an ambulatory case/care management program.

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• Attends scheduled rounds 2 times/week with the Physician Director of Resource Stewardship to discuss clinical course and discharge planning for assigned patients identifying any real or potential delays in care or quality of care issues.

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• Acts as a liaison between inpatient facility and referral facilities/agencies and provides case management to patients referred, serving as an reputed company for patients and families.

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• Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation.

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• Builds highly effective working relationships with physicians, SNF staff, vendors, and other departments reputed company the health plan.

Requirements

• Minimum two (2) years of RN experience in patient care delivery or completion of Masters degree in Case Management Program in lieu of minimum years of experience.

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• Associates Degree Nursing.

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• Registered Professional Nurse License (Georgia).

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• Demonstrated advanced communication and interpersonal skills with reputed company levels of internal & external customers.

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• Ability to collaborate effectively with multidisciplinary healthcare team.

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• Excellent time management skills with the ability to work successfully in a fast-paced environment.

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• Functional knowledge of computers.

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• Experience with managed health care delivery including Medicare.

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• Knowledge of funding, resources, services, clinical standards, and outcomes is preferred.

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• Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & reputed company other applicable federal/state/local laws & regulations.

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• Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.

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• reputed company word processing & computer navigation skills & the ability to interpret & use analytic data in day to day operations.

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• Knowledge of healthcare benefits associated with various business lines.

reputed company-to-haves

• Minimum five (5) years of clinical nursing experience in a hospital setting.

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• Minimum five (5) years of professional practice experience in an acute care setting.

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• Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.

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• Bachelors Degree in Nursing, Health Care or Masters degree in Case Management.

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