This position functions autonomously and in collaboration with all members of the healthcare team to coordinate and facilitate quality, cost-effective care while minimizing fragmentation of the healthcare delivery system for ESRD and CKD patients.
In this role, you will be responsible to
assist members with the transition from a care facility back to their home. Support members with condition education, medication reviews and connections to resources.
In this role, you will be helping Obtain initial authorizations from HMO's / Medical Groups, managing referrals and negotiating with HMO and managed care Case Managers, Tracking and managing care provided to ensure maximum efficiency, proactive and effective service provided to Residents with skilled healthcare needs and performing a key leadership role during managed care plan meetings.
In this role, the selected candidate will provide hospital case management services, including but not limited to utilization management and discharge planning, to assigned patients to assure efficient, cost-effective patient progression from admission through discharge.
In this role, you will provide leadership by working cooperatively and effectively with physicians, ancillary staff and other administrative and support personnel in maintaining the standards of professional nursing practice.
This position assesses the patients plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patients health care needs.
As a member of the clinical team, completes assessment and service plan and implements services to members in accordance with their individualized service plan (ISP). Communicates and documents member's progress toward their recovery.
In this role, the candidate is responsible for coordinating and facilitating the patient's hospitalization from pre-admission through post-discharge. Collaborates with physicians, nurses, social workers and other health team members to expedite medically appropriate cost effective care.
In this role, you will coordinate with all staff necessary to develop a mechanism to monitor patient progress against guidelines and evaluate variances for individual patients and targeted populations.
In this role, the selected candidate will maintain patient tracking addressing: open/close dates; diagnosis codes; treatment plan; annual assessment; demographics; and health insurance coverage according to RBHA guidelines.
In this role, you will maintain accurate record (system) of case management interventions including cost/benefit analysis, savings, and data collection. Adheres to quality assurance standards and all case management policy and procedures.