- Interprets and implements the facility’s Case Management Policy and Procedures.
- Ensures facility compliance with federal and state regulations involving Case Management Practice.
- Assures that patient receives quality patient care regardless of insurance coverage.
- Utilizes InterQual –Screening criteria for all admissions and observation status patients.
- Does the initial screening of all elective inpatient admissions related to:
- Level of Care
- Appropriateness of Admission
- Discharge Needs
- Third party contractual arrangements
- Appropriate resource utilization
- Documents patients admitted directly. Forwards the information on to the IPA/Insurance Case Managers as appropriate with discharge planning concerns and the initial discharge-planning screen
- Current LVN license required.
- Preferred Case Management experience utilizing MCG ( Milliman Care Guidelines ).
- Ability to work independently and responsibly with minimal supervision.
- Ability to interact and communicate with medical staff, hospital personnel, patients and families.
- Ability to identify problems generates and analyzes feasible solutions and implements course of action.
- Strong written and verbal communication skills.
- Basic computer skills required.
- Ability to be tactfully assertive and proactive in accomplishing job functions on time.
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