Inpatient Care Manager RN Per-Diem, Days,Case Management MMC

Location

Morristown, NJ | United States

Job description

Atlantic Health System is seeking a per diem Inpatient Care Manager (RN) for the Care Management Department at Morristown Medical Center to work 8AM-4PM, including 1 weekend shift per month. 

Minimum Education:

• High School diploma or GED required
• Graduate of an accredited Nursing Program required 
• BSN preferred

Minimum Experience:

• 2 years Acute Care experience preferred
• Candidate must have excellent communication and computer skills.

Licenses/Certification:

• Valid New Jersey Nursing License Required
• BLS Certification Required
• CCM Certification preferred

Essential Functions/Responsibilities:

• All patients are assessed within one business day of admission for appropriateness of
  admission, level of care & discharge needs. Initial assessment w ill identify patients support system, discharge barriers, prior level of
  functioning, previous admissions, community use of services, home care, durable medical equipment, etc. & confirms demographics &
  payer source. Develops an anticipated discharge plan. Identifies & initiates referrals for other services as indicated: social work,
  physical therapy, financial counseling etc. Reassesses for changes in patients condition or patient/family circumstances to amend
  discharge plan & identify patients medical readiness for discharge. Communicates & documents discharge plan with interdisciplinary
  team.
• Applies appropriate guidelines for all initial & concurrent reviews to determine
  LOC. Documents all review s using SI, IS format. For all LOC determinations that are inappropriate for inpatient CM actively confers
  with attending and refers to PA in a timely manner. Gives thorough admission & continued stay review s and faxes to appropriate
  payer via Allscripts in a timely manner. Demonstrates know ledge & follow s Medicare requirements, including initiating IM letter at
  admission, discharge & appeal follow -up. Concurrently identifies days at risk for denial or lower level of care & proactively initiates
  strategies to gain acute inpatient authorization. Documents delays in the Allscripts system. Identifies system problems impacting
  patient care/progress & initiates resolution to help reduce length of stay. Demonstrates comprehensive know ledge of Medicare criteria
  for both inpatient and outpatient status utilizing Milliman Care Guidelines. Educates patients, families and physicians regarding LOC
  Milliman guidelines and LOC status.
• Assesses patient within one business day of admission and takes a proactive approach in
  anticipating and facilitating their discharge needs ie: ordering wound vacs, ordering DME/O2, arranging VNA or infusion, etc.
  Communicates general benefit information to patients/families regarding coverage. Initiates, coordinates& ensures the discharge plan
  is moving forward. Obtains authorizations. Communicates the initial discharge plan to the patient, family, physician, & team members
  to ensure agreement. Attends family meetings as necessary. Identifies actual & potential issues with the discharge plan & develops
  strategies to resolve these issues. Collaborates & communicates with external case managers in a timely manner to initiate discharge
  plan. Communicates/educates patients & families regarding length of stay, discharge process, & available resources. Negotiates with
  payers regarding options for the continuing or alternate care plan based on medical necessity. Collaborates with Social Services for
  patients requiring complex discharge plans.
• Ensures discharge plan consensus with patient/family, physician & payer &
  documents. Collaborates & communicates with external care/case managers in a timely manner to obtain authorizations. Ensures that
  all CM documentation is complete in Allscripts & the Medical Record including initial/ transfer assessment within one business day of
  admission/transfer as w ell as ongoing assessments. re:patient and family encounters. Participates in daily & long stay rounds &
  coordinates follow -ups to resolve issues. Participates in family meeting. Responds to phone calls/emails in a timely manner .
  Consistently uses SBAR communication as either the receiving or sending Care Manager by providing additional information &
  completing Universal Transfer Form in Medical Record. Completes all documents as required by hospital policy including IPOC & Patient
  Education Forms, Pathway/Guidelines as needed

Job tags

Salary