Job description
Job Title:
Registered Nurse (RN) Case Manager -
UR focused with overlapping care coordination/discharge planning
Academic Background:
Active RN Licensure in the state of TX
Experience:
3+ Years | Background in the Inpatient & ED Setting
Salary Range:
90K Salaried
Overview: Beam Healthcare is looking for an RN case manager, who will be responsible for our inpatient & ED case managment program. The role of the RN-Case Manager will help ensure patients are appropriately managed from admission through discharge. Tele-coverage for a inpatient setting in Texas.
Schedule of Tele-Coverage Service
- Monday through Friday, 8:30am - 4:00pm cst
Daily Job Responsibilities:
- Actively work with ER/Hospitalist for any new obs/admission request to ensure proper status from admission.
- Ensures compliance with Condition of Participation (CoP) discharge planning.
- Identifies and escalates gaps/barriers related to inpatient and observation length of stay.
- Attend Patient/Family meetings as needed.
- Assesses patients at high risk for readmission. Identifies root cause for readmission. Develops plan and collaborates with multidisciplinary team regarding discharge planning to next level of care.
- Provides discharge care coordination for HHS, Hospice, ALF, and SNF. Communicates with health unit coordinator for appointments/follow ups and therapy re: DME needs prior to and upon discharge.
- Participates with other members of team regarding opportunities for improvement in standard work.
- Actively participates in utilization management process, admission process, and act as a case manager liaison with post acute providers (skilled nursing facilities, rehab, home health, etc.).
- Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department’s Scope of Service.
- Performs other duties as assigned.
Administrative Responsibilities:
- Utilization review on an ongoing basis.
- Lead monthly UR meeting includes monthly reports with trends and input. This will also be sent to CEO, CFO, CNO, and Hospitalist director + Med Surg manager.
- Aid in Insurance authorization coordination.
- Weekly meeting prn with PFS regarding authorizations and denied claims.
- Denial coordination with the business office on hospitalized patient denials.
- Coordinate peer to peer requested by the business office and provide the business office supportive clinical information.
- Prepare for Monthly UR meetings including monthly reports with trends and input.
Required Skills:
- 3+ years experience in prior case manager experience in the inpatient setting.
- Graduate of accredited school of nursing or education equivalency for licensing
- Proficiency with case management software platforms - InterQual and Milliman
- Excellent written and verbal communication skills.
Highlights:
- Work from Home, get the time back spent traveling to and from work.
- Join a group of passionate individuals with a vision of Healthcare Equality.
About Beam Healthcare:
Beam Healthcare is looking for an RN Case Manager to join our growing team of providers, administrators, analysts & friends who share the vision of Healthcare Equality. Our partnerships with all types of healthcare organizations are strengthened by our commitment to providing quality-based care with a team-based approach.
Our motto of “Telemedicine Moving Forward” signifies a proactive approach to system change,whereby we enhance patient care in communities we serve by implementing evidence-based,innovative solutions. This allows us to exceed quality goals while building a strong foundation for the future of medicine. The future of medicine is not limited by social or geographical boundaries. Are you ready to extend the reach of your expertise?
