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Rn case manager part time


This is a Part-time position in San Marcos, CA posted February 23, 2020.

Description Registered Nurse Case Manager Central Texas Medical Center Location Address: 1301 Wonder World Dr., San Marcos, TX 78666 Top Reasons to Work At Central Texas Medical Center, San Marcos, TX Be part of a team dedicated to providing Texas Hill Country residents with the best medical care possible, as evident by CTMC being named a Center of Excellence for bariatric surgery, knee replacements and primary stroke care by The Joint Commission.

CTMC’s highest priority is the safety of its patients and staff.

Recently, CTMC was the recipient of the Premier Hospital Improvement Innovation Network (HIIN) Excellence in Patient Safety Across the Board Award and is a five-time recipient of the Leapfrog Group’s ‘A’ for patient safety.

In back-to-back years, CTMC has received the American Heart Association/American Stroke Association’s Get with the Guidelines® Stroke Gold Plus Quality Achievement Award, recognizing the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment .

Located near colleges and universities to expand your career by offering tuition reimbursement.

Just one of the perks of the extraordinary benefits package.

CTMC’s CREATION Health Institute was created to provide information, education, health screenings and events that emphasize a healthy lifestyle.

Offerings such as HealthCheck, disease management, support groups, women’s health, nutrition, healthy living for seniors and children’s health are provided to the public for free or a minimal fee.

CTMC is a proud member of the AdventHealth System.

Work Hours/Shift: Part Time Every Other Weekend You Will Be Responsible For: Utilization Review/Management Responsibilities: Assess for appropriate level of care and admission status utilizing nationally recognized criteria such as InterQual/Milliman.

Promotes appropriate documentation which will accurately support the severity of illness and intensity of service.

When documentation is not reflective of the severity of illness and intensity of service, immediate discussion with the admitting physician will be provided to educate and facilitate the necessary documentation.

The CM will demonstrate the ability to discuss difficult/sensitive subjects with physicians in an articulate and professional manner.

Confirm the diagnosis identified as the reason for admission.

Request documentation to support admission.

Confirm that the clinical symptoms/treatment, including severity of illness and intensity of service per Interqual guidelines for admission are met, as well as, payer guidelines for admission and continued stay.

Maintains up to date knowledge of payer guidelines including Medicare, Medicaid, Commercial Insurance, Managed Care Plans, etc.

Confirm that the defined level of care/status is appropriate for the identified treatment plan.

Identifies readmissions and makes the appropriate referrals as needed to meet the needs of the patient.

Documents Readmission Assessments appropriately and timely.

Documents Avoidable Days appropriately and timely.

Enters the Utilization Management review on all screened admissions.

Continues to reassess observation cases and outpatient in a bed cases throughout the length of stay, with the assistance of the ED/Admissions case managers, for potential conversion or discharge.

Enters the concurrent Utilization management reviews on all payer cases requiring clinical information.

Clinical information is faxed or transmitted electronically as needed.

Communicates to registration the need for inpatient authorizations.

Communicates to the Director of Case Management, House Supervisor, CNO or CFO as needed when a patient does not meet admission screening guidelines or continued stay guidelines and patient is admitted or remains in-house.

Supports cost containment efforts through resource management, reporting variances to department Director or Manager.

Discharge Planning Responsibilities: Proactively screens and assess patients assigned in order to determine discharge needs and establishes a viable discharge plan while collaborating with patients, families, and a multidisciplinary team.

Consults and collaborates with a multidisciplinary team on complex cases.

Provides consults and referrals for patients that may include: adoption, fetal demise, teen pregnancies (under 14 years of age), abused or neglected children, abused or neglected elderly, complex family issues, suicidal patients, patients with a terminal diagnosis and/or patients who are victims of domestic violence.

Maintains knowledge of payer guidelines governing discharge planning; including Medicare, Medicaid, Commercial Insurance, Managed care, etc.

Documents discharge plans in the patients chart and communicates the plan to all parties involved including patient, family, physician, nursing, etc.

Actively participates in continuous quality improvement and is fiscally responsible when using charitable hospital resources .

General Responsibilities: Case Manager follows all departmental and hospital safety policies, including identification and correction of environmental and practice safety issues Develops self professionally and participates in hospital and departmental activities.

Assists in the development, implementation and evaluation of policies, standards, educational services, and programs that support the CTMC mission.

Represents the Case Management Department on interdisciplinary teams.

These may include committees/meetings within the organization or out in the community.

Demonstrates initiatives in developing, implementing and analyzing quality improvement strategies for the case management department.

Initiates activities to enhance revenue and support cost reduction and containment activities.

Rounds with the physician when appropriate or upon request.

Performs other duties as assigned.

Qualifications What You Will Need:
· Experience in case management preferred Job Summary: To provide initial screening for the majority of admissions that will occupy a bed overnight for admission criteria, status, and level of care.

This position will assist physicians and staff with obtaining accurate information surrounding status and provide direction and education regarding documentation and additional services available to the patient.

Ensures that the patient is provided discharge planning services, referral services, screenings and assessments while maximizing the resources available to the patient in the acute care setting.

Ability to perform in a fast paced, high-pressure environment This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.