Case Manager RN - Case Management

Company: CHI St. Luke's Health - Patients Medical Center
Location: Pasadena
Posted on: March 13, 2023

Job Description:

Case Manager RNOverview

Patients Medical Center (PMC) provides inpatient and outpatient medical and surgical services to residents of Pasadena, Deer Park, La Porte, Baytown, and Clear Lake. The facility includes 53 medical/surgical beds, eight ICU beds and three endoscopy rooms, and offers a range of primary and specialized services-wound care, general surgery, gastroenterology, occupational health, heart and vascular, women's services, diagnostic imaging, outpatient rehab services, and sleep disorders.g for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.

Coordinates patient care between patients, caregivers, and the multidisciplinary team; collects and evaluates information to facilitate care by assuring that admissions, continued stays, and ancillary services are medically necessary, cost-effective, and providing the appropriate setting to qualify for reimbursement. The case manager intervenes when necessary to assure that case is care is coordinated and timely.

Responsibilities

* Documents on the day of admission, or within the first twenty four hours, a clinical assessment and anticipated discharge plan that addresses use of the full continuum of care
* Provides plan of care updates to providers inside and outside of the hospital, working with patients and caregivers
* Continually Assesses and modifies the plan of care based on clinical need and patient preference
* Manages each patient's plan of care and throughout the stay
* Leads interdisciplinary rounds to coordinate care with the care team, and to address changes in the discharge plan
* Consults with appropriate physicians on plan of care and discharge
* Remains current of Medicare and Medicaid laws and guidelines, Medicare Conditions of Participation, managed care contracts, and other legal and regulatory requirements as they relate to health care case management services. Assures patients are informed of rights and responsibilities as participants in these programs.
* Dependent on the facility the following responsibilities may be required:
* Identify and execute discharge planning needs determined through patient/significant other contact, chart reviews, health care team rounds and clinical pathways and protocols. The continuum of care may extend from time of admission through the Rehabilitation phase.
* Liaise with physicians, patient benefits, and third party payers to identify, reconcile and execute necessary actions for services rendered, ensuring appropriate services and reimbursement.

Qualifications

Education and Licensure:

Bachelor's Degree - Nursing OR ADN and 5 years of clinical experience

Registered Nurse (RN) licensure

Minimum Experience:

Two (2) years of clinical nursing experience in the acute care or medical setting OR ADN and 5 years of clinical experience

Keywords: CHI St. Luke's Health - Patients Medical Center, Pasadena , Case Manager RN - Case Management, Executive , Pasadena, Texas