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Posted : Friday, March 29, 2024 08:36 AM
The Rehabilitation Center Case Manager plans, coordinates, develops, evaluates, and monitors the care of IRF patients to achieve quality cost effective patient outcomes.
Works collaboratively with interdisciplinary teams to identify services required to meet the patient/family needs throughout the continuum of care, while ensuring that appropriate resources are implemented in a timely manner.
Meets with all new admissions to identify and discuss a proposed discharge plan and then follow the progress of the discharge plan until discharged.
Set-up post discharge services such as home health, dual durable medical equipment, returned to home, swing bed, etc.
Attends weekly Team Conference meetings.
Reviews and understands approved length of stay and follows team recommendations for extensions or for setting discharge dates.
Demonstrates knowledge and skills to appropriately communicate and interact with the patients, families, and visitors while being sensitive to their cultural and religious beliefs.
Provides case management to improve placement of patients in the most appropriate care setting.
Collaborates with physician and interdisciplinary teams regarding medical necessity to assist in validating appropriateness of admission, services, and continued stay and, if necessary, issue letters of non-coverage.
Collaborates with the Rehab Team and physician regarding physician orders for appropriateness or documentation for supporting medical necessity.
Functions as the central liaison between the Medicare QIO, review agencies, Business Services, Patient Financial Services, and other healthcare professionals affected by concurrent review, and discharge planning.
Performance Expectation: Performance Expectations that are job specific will be covered during your department orientation.
You will be assessed for your competency of these expectations during your first 90 days of employment Accomplishes work in ways that maximize productivity.
Responds positively to and has the aptitude to deal with multiple tasks Demonstrates proficiency in required computer documentation of all assessments, communications, and interventions according to policy Demonstrate the ability to manage daily workload.
Demonstrate the ability to learn and follow various regulatory guidelines.
Demonstrates practices of all establish patient safety and infection control intervention.
Demonstrates the ability to assist with obtaining working diagnoses, working procedure codes or etiologic diagnosis.
Performs timely reviews concurrently on assigned patients relative to the prospective payment system for Medicare, Medicaid, private payers, and other hospital utilization management applications.
Monitors denials and assists with the appeal process as needed.
Assembles, analyzes, monitors, and tracks data for reporting as designated by the Manager/Director.
Is involved in utilization review activities as needed.
Participates on various committees/ task forces as needed.
Qualifications: Education/Skills Graduate of a recognized non-online LPN program required or Master’s degree in Medical Social Work program required.
Work Experience: Two or more years of experience in clinical nursing or social work experience in a health related facility required.
Case Management and/or Utilization Management experience preferred.
Certification/Licensure-DUE UPON HIRE If Nursing: Licensed LPN able to practice within the State of MS If Social Worker: Licensed Social Worker (LSW) as defined by Section 75-53-1 of the Mississippi Code of 1972.
Mental Demands: Exceptional oral and written skills are required to relate effectively to hospital staff, physicians, physician office staff, and review agencies.
The individual must have the ability to type and be familiar with the rules of spelling, grammar, and punctuation.
The individual must have the ability to use a copier, telephone, and personal computer.
Workable knowledge of DNV standards and other regulatory systems is essential.
Workable knowledge of correct coding procedures, CMS criteria, Rehab Perspective Payment System and medical terminology is necessary.
The individual must have a high energy level and be capable of handling pressure situations both mentally and physically.
Works collaboratively with interdisciplinary teams to identify services required to meet the patient/family needs throughout the continuum of care, while ensuring that appropriate resources are implemented in a timely manner.
Meets with all new admissions to identify and discuss a proposed discharge plan and then follow the progress of the discharge plan until discharged.
Set-up post discharge services such as home health, dual durable medical equipment, returned to home, swing bed, etc.
Attends weekly Team Conference meetings.
Reviews and understands approved length of stay and follows team recommendations for extensions or for setting discharge dates.
Demonstrates knowledge and skills to appropriately communicate and interact with the patients, families, and visitors while being sensitive to their cultural and religious beliefs.
Provides case management to improve placement of patients in the most appropriate care setting.
Collaborates with physician and interdisciplinary teams regarding medical necessity to assist in validating appropriateness of admission, services, and continued stay and, if necessary, issue letters of non-coverage.
Collaborates with the Rehab Team and physician regarding physician orders for appropriateness or documentation for supporting medical necessity.
Functions as the central liaison between the Medicare QIO, review agencies, Business Services, Patient Financial Services, and other healthcare professionals affected by concurrent review, and discharge planning.
Performance Expectation: Performance Expectations that are job specific will be covered during your department orientation.
You will be assessed for your competency of these expectations during your first 90 days of employment Accomplishes work in ways that maximize productivity.
Responds positively to and has the aptitude to deal with multiple tasks Demonstrates proficiency in required computer documentation of all assessments, communications, and interventions according to policy Demonstrate the ability to manage daily workload.
Demonstrate the ability to learn and follow various regulatory guidelines.
Demonstrates practices of all establish patient safety and infection control intervention.
Demonstrates the ability to assist with obtaining working diagnoses, working procedure codes or etiologic diagnosis.
Performs timely reviews concurrently on assigned patients relative to the prospective payment system for Medicare, Medicaid, private payers, and other hospital utilization management applications.
Monitors denials and assists with the appeal process as needed.
Assembles, analyzes, monitors, and tracks data for reporting as designated by the Manager/Director.
Is involved in utilization review activities as needed.
Participates on various committees/ task forces as needed.
Qualifications: Education/Skills Graduate of a recognized non-online LPN program required or Master’s degree in Medical Social Work program required.
Work Experience: Two or more years of experience in clinical nursing or social work experience in a health related facility required.
Case Management and/or Utilization Management experience preferred.
Certification/Licensure-DUE UPON HIRE If Nursing: Licensed LPN able to practice within the State of MS If Social Worker: Licensed Social Worker (LSW) as defined by Section 75-53-1 of the Mississippi Code of 1972.
Mental Demands: Exceptional oral and written skills are required to relate effectively to hospital staff, physicians, physician office staff, and review agencies.
The individual must have the ability to type and be familiar with the rules of spelling, grammar, and punctuation.
The individual must have the ability to use a copier, telephone, and personal computer.
Workable knowledge of DNV standards and other regulatory systems is essential.
Workable knowledge of correct coding procedures, CMS criteria, Rehab Perspective Payment System and medical terminology is necessary.
The individual must have a high energy level and be capable of handling pressure situations both mentally and physically.
• Phone : NA
• Location : 214 South 28th Avenue, Hattiesburg, MS
• Post ID: 9126686792
