Remote RN Admissions Case Manager - PRN

Job Description:

This determines the psychosocial, environmental, and family economic dynamics that may affect the patient. Functions as the liaison and communicator with the patient, caregivers, multi-disciplinary team members, and post-acute care and third party payers. Confirms a clear, specific care setting order by the physician and applies hospital approved medical necessity criteria to review appropriate admissions and levels of care. Documents completed reviews in the hospital approved data set.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.

Education

Required - Registered nurse diploma.

Preferred - Associate's degree in nursing.

Work Experience

Required - 1 year of hospital-based experience in the delivery of patient care.

Preferred - Experience in case management or utilization review.

Certifications

Required - Current Registered Nurse license in state of practice.

Preferred - Commission for Case Manager (CCM), Certified Professional Utilization Review (CPUR), Certified Professional in Utilization Management (CPUM) or Certified Professional in Healthcare Management (CPHM) certification.

Knowledge Skills and Abilities (KSAs)

• Proficiency in using computers, software, and web-based applications.
• Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
• Good knowledge of business/finance.
• Ability to work a flexible work schedule (e.g. 24/7, weekend, holiday, on-call availability) and travel throughout and between facilities.

Job Duties

• Directs and coordinates all admissions and transfers to, from, and within the hospital while coordinating with parallel processing of Environmental Services (EVS) and transport operations that tie into patient flow.
• Facilitates professional relationships between unit leadership, operational coordinators, nursing staff, Regional Referral Center, medical staff, admitting office and interdisciplinary teams to provide patient/room assignment based on patient diagnosis, acuity, MD orders and patient flow.
• Manages aspects of the planning process in anticipation of the patient’s movement through the healthcare system.
• Interacts with managed care/ third party payers to obtain financial certification for appropriate reimbursement and to minimize reimbursement denials.
• Manages the care of assigned patients through the healthcare system based on the patient’s individual needs, serving as a contact person for the rehabilitation team, internal admissions team, clients and external sources to enhance outcomes.
• Educates clients, family members or significant others, referral sources, hospital personnel, external payers, and internal/external case managers as to rehabilitation program benefits and services.
• Adapts behavior to the specific patient population, including but not limited to respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.
• Performs other related duties as required.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state, and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations, and standards.

Physical and Environmental Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects.  (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work.

Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.

Duties performed routinely require exposure to blood, body fluid, and tissue.

The incumbent works in a patient care area; works in an area where patients enter; works directly with patients; and/or works with specimens that could contain diseases. There may be an occupational risk for exposure to all communicable diseases.

Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.