RN or LPN Case Manager-Skilled Nursing Unit in Hattiesburg, Mississippi at Forrest General Hospital

Job Summary:

Helps plan, coordinate, develop, evaluate, and monitor the care of the assigned group of patients to achieve quality cost effective patient outcomes. Works collaboratively with interdisciplinary teams to identify services required to meet the patient/family needs throughout the continuum of care, while ensuring that appropriate resources are implemented in a timely manner. Demonstrates knowledge and skills to appropriately communicate and interact with the patients, families, and visitors while being sensitive to their cultural and religious beliefs. Provides case management to improve placement of patients in the most appropriate care setting. Responsible for and uses the InterQual criteria to ensure proper placement of patients to the Skilled Nursing Unit. Keeping InterQual assessments current and on schedule. Collaborates with physician and registration staff regarding medical necessity and Local Medical Review Policies (LMRP) to assist in validating appropriateness of admission, services, and continued stay and, if necessary, issue letters of no coverage. Collaborates with registration staff and physician offices to obtain physician orders. Performs reviews concurrently on assigned patients relative to the prospective payment system for Medicare, private payors, and other hospital utilization management applications. Serves as the initial contact healthcare providers have with the process of PDPM assignment. Functions as the central liaison between the Medicare PRO, review agencies, Business Services, Patient Accounts, and other healthcare professionals affected by PDPM assignment, and the certification process, and discharge planning. Is involved in utilization review activities as defined by the Performance Improvement Plan and participates on various committees/ task forces. Assembles, analyzes, and types materials for reports, spreadsheets, data collection and tracking. Other duties required are cross training of other positions including but not limited to: Being proficient in EPIC documentation and where to find information needed to collect and input MDS data into the Epic LTC/MDS and/or jRaven (utilized for backup), assigned patient interviews, being able to fill in on the unit as a medication nurse when needed, keeping track of re-admissions, assisting with insurance updates, chart audits, filling in for social services when needed to set up home health and DME/coordinate discharge plan, assist with team meetings, discuss insurance coverage with families, filling in and assisting with pre-screening/admissions as necessary.

Appendix for case manager-admissions: Expectations are to maintain census for 30 bed unit; working until 6pm M-F (as required, if not daily) and to VPN, prn, on Saturday (only when needed) to ensure certifications for admission or re-certs are received and processed timely and to complete any and all require admission worksheet/consult and/or MD communication required for SNU admits. This means to balance admissions and discharges on SNU to maintain acceptable census level for 30 bed unit and other duties as specified.

Performance Expectations:

• Demonstrates the aptitude to assess and investigate potential candidates for admission, including face to face with potential resident and family
• Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served; also demonstrates knowledge of the principles of growth and development and possesses the ability to assess data reflective of the patient’s status and interprets the appropriate information needed to identify each patient’s requirements relative to his/her age specific needs, and to provide the care needed.
• Demonstrates good customer services skills.
• Maintains annual competencies for skilled nursing.
• Demonstrates the aptitude for safely positioning and assisting patients using a variety of devices such as but not limited to abduction pillows, splints, slings, braces, neck collars, walkers, crutches and immobilizers.
• Implements a systematic and comprehensive plan of care to provide individualized care, educates patient and family about diagnosis, treatments or prescribed regimen and medications in accordance with patient and family readiness and ability to learn.
• Demonstrates knowledge of the care plan process and their responsibility of documentation.
• Demonstrates ability to do Utilization Review with insurance companies.
• Demonstrates ability to keep the current census information required, along with admissions and discharges for the unit.
• Demonstrates a professional relationship with social workers, case managers and families of potential admissions.
• Demonstrates the ability to keep InterQual assessments up to date to ensure that our residents qualify to be on a Medicare unit.
• Demonstrates the ability to switch roles and work as the primary care nurse or Patient Care Coordinator when the need arises.
• Embraces and practices the We Care philosophy in all aspects of patient, visitor, co-worker, employee and non-employee interactions.
• Consistently follow the Skilled Nursing policies, patient care services and FGH policy, procedures, and standards of care in performing nursing duties.

Qualifications:

Education/Skills

RN or LPN Nursing degree from an accredited non-online university required.

Work Experience:

One or more years’ experience at Forrest Health in clinical nursing required. Case Management and/or Utilization Management experience preferred.

Certification/Licensure-DUE UPON HIRE

• Licensed RN able to practice within the State of MS

Additional Certification/Licensure - Obtained based on required timeframe below

• Basic Life Support

Within 30 Days of Employment

Required

Mental Demands:

Exceptional oral and written skills are required to relate effectively to hospital staff, physicians, physician office staff, and review agencies. The individual must have the ability to type and be familiar with the rules of spelling, grammar, and punctuation. The individual must have the ability to use a copier, telephone, and personal computer. Workable knowledge of CMS standards and other regulatory systems is essential. Workable knowledge of correct coding procedures, InterQual criteria, Milliman Care Guidelines, Perspective Payment System and medical terminology is necessary. The individual must have a high energy level and be capable of handling pressure situations both mentally and physically.