Case Manager (RN) - PRN | Greeley Rehab
Post Acute Medical
- Greeley, CO
- $48.00 per hour
- Permanent
- Full-time
- Assesses, plans, monitors, and coordinates plan of care from pre-admission to community re-entry through the implementation of case management standards and processes.
- Assesses the individual’s personal and medical history, current status, diagnosis, prognosis, and the proposed treatment plan.
- Promotes and utilizes the appropriate level of care for the patient and refers to other facilities as needed.
- Adheres to contract agreements and specific criteria.
- Serves as a liaison with payor source points of contact to verify and guarantee coverage and identify items required to process the claim for service.
- Assists patient and or caregiver in developing realistic goals to direct the treatment regimen.
- Proactively communicates with payor source to explore coverage solutions (flex benefits, out of contract, etc.).
- Promotes optimal outcomes for the patient within the boundaries of the diagnosis.
- Coordinates and facilitates interdisciplinary team (IDT) meetings and plan of treatment.
- Meets with patient, family, and IDT to facilitate “continuity of care”.
- Implements utilization review process and continuously evaluates the appropriate level of care with the interdisciplinary team and payor, and patient/caregiver(s). Proactively obtains authorization for any extension of service of LOS.
- Coordinates the discharge plan with the IDT and providers.
- Monitors expense versus revenue for caseload on a daily basis.
- Proactively collaborates with the health care team, payors, community agencies, providers and legal representatives to ensure continuity throughout the continuum.
- Serves as a liaison with the treatment team and the primary care physician, referring physician, medical director, patient/caregiver(s), and other parties as appropriate.
- Promotes effective communications among treatment team members, patient/caregiver(s), primary care physician, referring physician, medical director, and payor.
- Participates in care conferences, family conferences, etc. when indicated.
- Educates and supports the individual/family to be empowered and self-reliant in being advocates for themselves.
- Uses the mechanism of early referral to promote and provide optimum care and cost containment.
- Represents the individual’s best interests through assisting in finding necessary funding, offering treatment alternatives, and coordinating treatment.
- Continuously reviews and evaluates the patient’s progress, as reflected by the goals defined in the treatment plan.
- Uses appropriate auditing processes and tools to ensure department and treatment efficiency.
- Participates in performance improvement evaluation processes with particular emphasis on results-oriented treatment.
- Maintains professional growth in case management by: attending continuing education opportunities; reviewing pertinent professional literature; maintaining knowledge of current community resources; and reviewing and being familiar with the managed care marketplace to determine managed care growth potential, opportunities, penetration, service trends, relationships, networks, etc.