Facilitate authorization/certification of procedures, diagnostic testing, physical therapy / occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed.
The Nurse Case Manager collaborates with other members of the case management and health care teams, utilizes professional nursing skills to: assist the patient in achieving optimal health; assure appropriate use of health care resources; facilitate/coordinate timely care along the continuum; decrease unnecessary variances in care through proactive case management; develop a safe and timely discharge plan to meet the patients needs.
Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.
Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.
The Case Management Manager partners with medical staff to improve integrity of clinical documentation. Coaches staff in process of care management; seeks to integrate case management activities with nursing process.