RN Case Manager/UT Review

Susan B Allen Memorial Hospital•El Dorado, KS

15d•Onsite

About The Position

This role is responsible for managing patients within the skilled care program, ensuring they meet qualifications, facilitating necessary documentation, and coordinating care. The position involves patient assessment, care planning, documentation in the Electronic Medical Record, and collaboration with various departments and healthcare professionals. A key aspect of the role is maintaining knowledge of current regulations and ensuring proper reimbursement for services. The RN Case Manager also plays a crucial role in patient and family education and involvement in the care process.

Requirements

Graduate of a State Board approved or accredited school of nursing.
Must possess evidence of current Kansas license or valid temporary permit to practice (if coming from out of state).
Must be certified as an Activity Director from KDHE approved program within 6 months of start date.
A minimum training level of BLS is required.
Will be orientated to and maintain competence in working with adult and geriatric patients.
Competence at the beginning of employment will be measured through observation during orientation, math and medication administration testing, and review of documentation.
Ongoing competence will be measured through observation of clinical practice, observation for performance evaluation, competency in-service and testing, and math and medication administration testing.

Nice To Haves

BSN preferred.
Prefer a minimum of two (2) years of recent Resident Assessment Instrument Minimum Data Set (RAI-MDS) experience (within the past 5 years).
Prefer experience with and knowledge of current CMS regulations.

Responsibilities

Ensure appropriate patients are admitted to the skilled care program by working with UR, SW, and Department Director to identify candidates, verify qualifications, facilitate HINN issuance, discuss level of care changes with patients/families, and ensure timely physician orders and certifications.
Maintain patient census log for the skilled care program, including records of all screened and admitted patients.
Facilitate assessment of all patients admitted to the skilled care program.
Complete the Resident Assessment Instrument Minimum Data Set (RAI-MDS) according to Medicare schedule for Skilled Care.
Supervise and coordinate the Activities Program for Skilled Care/Swing Bed patients.
Perform the Essential Functions of the Nursing Activity Clerk.
Meet CMS requirements for initiating, updating, and maintaining the care plan.
Maintain knowledge about state-required assessments, including requirements on completion of the MDS, according to defined coding to ensure proper reimbursement for care.
Assist the Discharge Planning Team in reviewing and completing patient goals.
Facilitate interdisciplinary care for patients in the Skilled Care Program.
Attend and participate in Discharge Planning Team meetings.
Document patient information in the Electronic Medical Record.
Participate in quality assurance, assessment, and improvement activities.
Maintain current knowledge of the Skilled Care Program and applicable regulations, utilizing and attending skilled care continuing education.
Serve as a liaison between patients, families, physicians, management, and staff, communicating regularly with director, staff, and physicians.
Communicate the Resource Utilization Group (RUG) category and other clinical information needed to process claims, maintaining a log of RUG categories and excluded services, and submitting information for timely billing.
Involve patients and families in the plan of care by discussing it with them and inviting them to care planning meetings as appropriate.
Review all care plans and goals with patients or families who did not attend care plan meetings.
Ensure patient information is shared with appropriate disciplines.
Collaborate with and assist the Social Work department in the Discharge Planning Process, ensuring the discharge plan is initiated, revised, patients/families are informed, and post-discharge needs are identified and addressed.
Serve as a resource for the patient, family, and physician, meeting as needed to address issues.
Collaborate with and assist Utilization Review Nurses.
Perform other duties as assigned.
Perform the Essential Functions of Ward Clerk.
Perform the Essential Functions of Staff Registered Nurse.