Summary: Role has multiple components: clinical, leadership, and educational. Major areas of accountability include utilization management, care co-ordination, discharge planning, and quality management. Goal is optimal patient care at appropriate level, in financially expedient and efficient manner. Inherent in this process is monitoring and tracking/trending of data. The Case Manager is responsible for monitoring of clinical documentation with guidance to physicians and extenders as needed. Compliance with all hospital COP’s
Utilization Management
- Insures care delivered in fiscally responsible manner
- Reviews inpatient, observation cases using nationally accepted criteria for appropriate level of care, discharge and continued stay
- Reports exceptions, variances to Utilization Review Committee and/or responsible staff
- Makes informed recommendations as to Level of Care, Length of Stay,
Documentation for medical necessity
- Insures payer requirements met to insure payment for services rendered. Appeals as needed. Monitor for trends, patterns and refers to Utilization Review Committee or appropriate staff
- Compiles, integrates information as needed
- Participates in Utilization Review Committee as member
- Acts as liaison with payers, CMS, QIO as needed
- Co-ordinates and educates hospital staff as needed
- Maintains current and up to date knowledge of current Utilization strategies
Case Management/Care Co-Ordination
- Strives for efficient care across the continuum
- Reviews continued stays using nationally approved criteria
- Tracks/trends information and reports to Utilization Review Committee and appropriate staff
- Assess patient for discharge needs
- Coordination of discharge needs with personnel for DME, HH, and follow up
- Insures payer requirements met for reimbursement
- Participates in educational programs such as Joint Camp as needed
- Is available for physician education/interaction
Discharge Planning
- Considers, addresses and coordinates needs outside of facility
- Assesses patient on admission or within one business day for discharge needs
- Coordinates, arranges services as needed
- Complies with payer requirements to maximize reimbursement for post discharge services and minimize cost to patient
- Complies with federal and state regulations concerning financial interest disclosure and choice of provider
- Compiles statistics and monitor for trends. Report as required to Utilization Review Committee and or responsible party.
Quality
- Continues to promote quality healthcare as a means to the goal of patient satisfaction
- Practices continuous vigilance for potential quality issues in all areas of expertise and all assigned areas
- Addresses concerns in a timely manner and appropriate fashion. Compiles information and statistics.
- Reports tracking and trending results to appropriate committee and department heads
- Continues to maintain current information to facilitate recognition of quality issue
- Maintains up to date information bank
Education and Experience
Degree or Formal Training: Associate or Bachelor's Degree in Nursing
License, Certificate or Registration: Current LA State Licensure
Additional Information:
BLS Required
Benefits are offered with this position after a waiting period.
Specialists Hospital Shreveport provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Specialists Hospital Shreveport, LLC
Specialists Hospital is proudly physician owned and is actively in involved in the Physician Owned Hospitals of America (http://www.physicianhospitals.org/) and the Louisiana Physician Owned Hospital Association (http://www.lhaonline.org/) . Specialists Hospital Shreveport located in Shreveport, Louisiana offers you state of the art treatment in orthopedic and spine surgery- all in a unique, patient-centered environment that is close to home. Whether you are undergoing an outpatient or inpatient procedure, the physicians and staff at Specialists are committed to providing you compassionate and expert care while allowing for a seamless transition from hospital to home. Specialists Hospital Shreveport is the only hospital in Louisiana that focuses solely on orthopedic, spine and spinal neurosurgery.
Página Web de la Compañía: www.specialistshospitalshreveport.com
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