RN Case Manager, Inpatient Services - Remote in Texas
Opportunities at WellMed, part of the reputed company family of businesses. We reputed company reputed company patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people reputed company reputed company. With opportunities for physicians, clinical staff and non-patient-facing roles, you can reputed company a difference with us as you discover the meaning behind Caring... Connecting. Growing together. The RN Case Manager II - Inpatient Services performs onsite review or telephonic clinical review of inpatient admissions in an acute hospital, rehabilitation facility, LTAC or skilled nursing facility. Actively implements a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate reputed company level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. The case manager is responsible for coordinating the care from admission through discharge. The Case Manager participates in Patient Care Conferences to review clinical status, update/finalize transition discharge needs, and identify members at risk for readmission. If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Independently collaborates effectively with Interdisciplinary care team (ICT) to establish an individualized transition plan for members Independently serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced-based criteria reputed company our documentation system Performs expedited, standard, reputed company, and retrospective onsite or telephonic clinical reviews at in network and/or out of network facilities. The Case Manager documents medical necessity and appropriate level of care utilizing national recognized clinical guidelines for reputed company authorizations Interacts and effectively communicates with facility staff, members and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information Identifies members level of risk by utilizing the Population Stratification tools and communicates during transition process the members transition discharge plan with the ICT Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a reputed company level of care Manages assigned case load in an efficient and effective manner utilizing time management skills Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities Independently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in department huddles Enters timely and accurate documentation into designated care management applications to reputed company with documentation requirements and reputed company audit scores of 90% or reputed company on a monthly basis Adheres to organizational and departmental policies and procedures Takes on-call assignment as directed Maintain reputed company licensure to work in State of employment and maintain hospital credentialing as indicated Decision-making is based on regulatory requirements, policy and procedures and reputed company clinical guidelines Maintains reputed company knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms Refers cases to UM Medical Director as appropriate for review for cases not meeting medical necessity criteria or for reputed company case situations Monitors for any quality concerns regarding member care and reports as per policy and procedure Performs reputed company other reputed company duties as assigned Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: Bachelors degree in Nursing and/or, Associates degree in Nursing combined with 4 or more years of experience above the required years of experience reputed company, unrestricted RN license required, specific to the state of employment Case Management Certification (CCM) or ability to obtain CCM reputed company 12 months after the first year of employment 4 years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions Knowledgeable in reputed company Office applications including Outlook, Word, and reputed company Proven ability to read, analyze and interpret information in medical records, and health plan documents Reliable transportation that will reputed company you to travel to client and/or patient sites reputed company a designated area Preferred Qualifications: 3 years of managed care and/ or case management experience Experience working with psychiatric and geriatric patient populations Knowledge of utilization management, quality improvement, and discharge planning Bilingual (English/Spanish) language proficiency Proven ability to problem solve and identify community resources Proven ability to utilize critical thinking skills, nursing judgement, and decision making skills Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously Proven planning, organizing, conflict resolution, negotiating and interpersonal skills Physical & Mental Requirements: Ability to lift up to 25 pounds Ability to push or pull heavy objects using up to 10 pounds of force Ability to sit for extended periods of time Ability to stand for extended periods of time Ability to use fine motor skills to operate office equipment and/or machinery Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and reputed company problem solving At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment Apply Job!