Case Manager - RNPosted: May 13, 2020
Responsible for coordinating and facilitating the patient's hospitalization from pre-admission through post-discharge. Collaborates with physicians, nurses, social workers and other health care team members to expedite medically appropriate, cost effective care. Applies clinical expertise and medical appropriate criteria to resource utilization and discharge planning to achieve desired health maintenance and disease prevention outcomes. Will advise the health care team and provide leadership as necessary. Communicates at inter-departmental level as well as across all health care areas with the goal of improving clinical management of patients, thereby impacting medical and psychosocial care across the health care continuum. Core processes include risk assessment and management of clinical populations, discharge planning, and utilization management. Provides assistance to patients and families through assessment and evaluation of psychosocial, emotional, and financial factors which impact health status and barriers to wellness.
Schedule: Full Time
Contact: Lesley Hixson
• Graduate of an accredited school of nursing required. BSN preferred.
• Current licensure to practice as a Registered Nurse in the State of New Mexico.
. Certification in Care Management preferred.
• Current BCLS required.
• Requires a minimum of three (3) years acute care experience, preferably in Care Management, Utilization Management, and/or Discharge Planning.
• Multidisciplinary approach to clinical improvement.
• Fiscal Management.
• Managed Care concepts and strategies; DRG reimbursement.
• Convert DRG and Physician practice pattern data information into quantifying data which impacts costs and quality.
• Ability to implement new programs and problem solving mechanisms.
• Strong interpersonal communication skills.
• Experience in developing and presenting education programs.
• Competent computer skills to include Microsoft Office programs
• Excellent knowledge of Medicare/Medicaid/Third Party admission and concurrent review criteria.
• Knowledge of "Benchmark" and "Best Practice" methodologies.
• Ability to implement and initiate workload changes and set priorities.
• Care Management Practice/Guidelines, to include analyzing, trending and reporting variances
• Working knowledge of Milliman.
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