Case Manager* - Care Coordination - FT - 780004
Company: Gerald Champion Regional Medical Center
Posted on: May 3, 2021
Provides for the development, coordination, and implementation
of care coordination services over the continuum of care. The
position will incorporate the traditional functions of Discharge
Planning, Quality, and Utilization Management with a focus on
high-risk inpatient populations.
- Submits appeals in a timely manner, upon request by the
Director. Initiates discharge planning on assigned patients within
24 hours of admission. Revises discharge planning as indicated by
changes in the patient's condition and circumstances. Arranges for
the post-discharge needs of patients. Clearly and accurately
documents all patient/family interventions and interactions.
Monitors for the efficient use of resources and reports to Director
when there are actual or potential sources of under- or
over-utilization. Collaborates with providers, nurses, patients,
families, and other care providers in the development and
implementation of patient care plans, including discharge planning,
across the continuum of care in support of the GCRMC Mission.
Communicates with providers regarding patient status and assists
him/her in ensuring proper placement of patient. Conducts
utilization review using nationally recognized medical necessity
criteria and documents the review. Refers cases for second level
reviews when medical necessity criteria are not met.
- Demonstrates familiarity with the various levels of care and
community resources available for each patient and the providers of
these different aspects of care. Actively participates in
interdisciplinary treatment planning rounds. Utilizes innovative
methods to facilitate development and implementation of discharge
plans. Makes self available as resource to nursing staff. Provides
learning experiences to strengthen and expand the staff's
expertise. Participates in infection control activities by
screening, monitoring, and reporting individual cases and/or trends
to the infection control nurse. Performs utilization management
functions as required by payer source. Complies with the
Utilization Management Plan.
- Bachelor's degree in Nursing or three + years of experience in
nursing preferred but other health care related education may be
considered based on experience. Experience in Care Management
preferred. Licensure: If a Registered or Licensed Practical Nurse
Currently Licensed to Practice in the State of New Mexico. Other
disciplines, licensure as required by State of New Mexico.
Certification: Current American Heart - Basic Life Support (BLS)
card. Five years recent relevant clinical experience in an acute
care facility required. Strong Interpersonal skills and ability to
work with patients, families, providers, peers, and other
departments required. Ability to use word processing and computer
spreadsheets and other computer-based programs required to do the
job. Excellent communication and problem-solving, and critical
thinking skills. Strong patient education abilities. Knowledge of
and experience with InterQual Level of Care Criteria, experience in
automated InterQual preferred. Knowledge of the regulatory
environment, including Medicare Conditions of Participation, DNV
standards, HIPAA, and reporting requirements.
Keywords: Gerald Champion Regional Medical Center, Las Cruces , Case Manager* - Care Coordination - FT - 780004, Other , Alamogordo, New Mexico
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