Status: Full Time
1. Previous Experience:
a.5 years nursing experience with a minimum of 3 years acute patient care required.
b.Previous management experience preferred.
c.Utilization Management/Case Management experience preferred.
2.Specialized or Technical Education
a.Registered Nurse licensed to practice in the State of Louisiana.
c.Knowledge of established medical necessity criteria and their application necessary.
d.Knowledge of the Inpatient and Outpatient Prospective Payment Systems – MS-DRG’s, CPT, ICD10-CM and HCPCS coding, is strongly preferred.
e.Knowledge of Social Services, discharge planning, community resources, and referral agencies required.
f.Basic knowledge of Legal Compliance/HIPAA and their application in Case Management practice is necessary.
g.Knowledge of third party payor methodologies and appeal processes necessary.
h.Knowledge of Quality Improvement activities/Team Leader/Facilitator training preferred
3.Physical Effort Required/Physical Demands:
A.Provides direct supervision for all staff in Case Management Department - RN Care Managers, Social Workers, ER Case Managers, Utilization Review Nurses, Patient Flow Navigator Nurses, and Volunteers.
B.Performs annual appraisal of employee performance for employees/positions supervised.
C.Informs the Case Management Director of any concerns, activities, and ideas for improvement brought to the manager by any member of the Medical Staff, other hospital or Case Management department staff.
D.Identifies issues and assists the Department Director in any disciplinary actions required by the employees supervised.
E.Determines staffing levels and ensures adequate coverage in all areas.
F.Responsible for reviews and updates of departmental policies and procedures, all department job s, and Plan of Care on an annual basis.
G.Maintains daily working knowledge of in-house cases and knows discharge plan for any patient with a length of stay greater than 5 days.
H.Informs the Case Management Director of any cases which do not meet criteria for admission or continued stay as well as cases with known or suspected problems with utilization of services.
I.Serves as the backup for the Case Management staff by being available by phone after hours, on weekends, and holidays. Reports to hospital when necessary to carry out the functions of the Case Management Department.
J.Responsible for the dissemination of information to the Case Management staff about changes in current rules, regulations, policies and procedures related to the Case Management Program.
K.Maintains working knowledge of screening criteria utilized in the Case Management process and is able to apply them objectively.
L.Maintains close professional ties to the Medical Staff and all hospital employees to facilitate the functions of the Case Management department.
M.Assists the Department Director with ongoing staff education and preparedness for Medicare, JCAHO, CARF and other accreditation surveys.
N.Oversees Utilization Review processes, including daily reviews, initial and continued stay authorizations, reconsiderations, and workque management.
O.Responsible for maintaining the daily functions of the department and overseeing all Case Management activities in the absence of the Department Director.
P.Assists the Director in monthly budget monitoring and analysis. Also assists the Director in annual departmental budget preparation and presentation.
Q.Follows North Oaks Health System’s Compliance Programs and Federal and State Regulatory guidelines.
R.Other duties as instructed by Case Management Director.
North Oaks Health SystemHammond, LA