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RN-Case Manager-(Full-time, Days): The Woman's Hospital of Texas

POSITION SUMMARY:
Under the supervision of the Director of Quality and Resource Management, the Case Manager is responsible for assisting in implementing the Resource Management Program to ensure ongoing assessment of patient care deliver according to established standards.

ESSENTIAL FUNCTIONS:
1. Reviews admissions and extended stays of all PPS, non-PPS, managed care, self-pay and other third party payors in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and standards approved by the medical staff.
2. In collaboration with the Director of Quality and Resource Management, maintains a data collection system for monitoring admissions and assigning extended stays in accordance with criteria approved by the Utilization Management Committee and Medical Staff with referral of all cases in question to the Utilization Management Physician Advisor.
3. Communicates with third party payors regarding extended stays for approval.
4. Coordinates Discharge Planning meetings with nursing and ancillary staff on individual nursing units to promote ongoing review of patient care activities related to provision of services, patterns of care, and utilization of resources.
5. Assists in Utilization Management Committee activities by providing data for reports, medical care evaluation studies, and maintenance of records as deemed appropriate.
6. Maintains liaison with Social Worker, and other individuals/groups responsible for discharge planning to facilitate continuity of care which may include initiating and/or coordinating discharge planning.
7. Other duties as assigned.
EDUCATION REQUIRED AND/OR PREFERRED:
REQUIRED: Associates or Bachelor's Degree

LICENSURE/CERTIFICATION:
REQUIRED: Current licensure in Texas as a Registered Nurse, Licensed Vocational Nurse or Registered Health Information Technician (RHIT).

EXPERIENCE REQUIRED OR PREFERRED:
REQUIRED: Experience in health care delivery systems with focus on Quality and Resource Management preferred.



SKILLS, KNOWLEDGE, AND ABILITIES:
Basic computer skills. Knowledge of case management. Ability to communicate well with others both written and verbal.