McLaren Health Care Case Manager RN in Pontiac, Michigan
Coordinates, negotiates, procures, and manages the care of an assigned patient population. The objective is to facilitate quality clinical outcomes, promote patient satisfaction, assist in managing length of stay, and oversee the discharge planning process.
Essential Functions and Responsibilities:
Conduct reviews for medical necessity on admission and for continued stay to insure patients meet criteria for hospitalization.
Obtains authorizations for hospital admission from payers when required.
Conducts a comprehensive assessment of the patient’s physical health status, functional capability, mental status, psychological needs, personal and community support, financial resources, and environmental conditions to develop and coordinate interventions needed to reduce barriers and formulate discharge plans.
Establishes course of action by exploring options; setting goals with client.
Obtains assistance for the patient by referring him/her to community resources.
Documents in the medical record: assessment, goals, plans, interventions, barriers, and reassessments as necessary to facilitate discharge.
Completes verbal orders in the electronic health record as directed by the physician.
Maintains effective operations by following policies and procedures; participating in quality reviews; reporting needed changes.
Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Complies with federal, state, and local legal and certification requirements by studying existing and new legislation; anticipating future legislation; enforcing adherence to requirements; advising management on needed actions.
Performs other related duties as required and directed.
Bachelor’s degree in nursing from accredited educational institution, or actively pursuing degree and to be obtained within three years of accepting position
State licensure as a Registered Nurse (RN)
Minimum experience of three years in acute hospital setting
Utilization management (review) and discharge planning experience.
Certification in Case Management, either CCM or ACM (Commission for Case Management or American Case Management Association)
Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association or equivalent through the Military Training network (MTN)
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans.
Job: Health Professional
Primary Location: Michigan-Pontiac-McLaren Oakland
Employee Status Regular
Shift Day Job
Job Type Standard
Req ID: 20009649