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Case Manager, CCM-RN-Acute Care
Job Description
- As a Nurse Case Manager you will be assigned a case load and will see all activities of the patient throughput from admissions to discharge.
- Conducts initial and ongoing assessment of each patient within your case load documents clinical condition, level of care, and plan of care.
- Reviews admission, pre-op orders for all components necessary for preadmission, admission process.
- Obtain prior authorizations, prior to surgery, procedures, and/or admission.
- Educates patient and family during patient stay and discharge
- Assist in the development of care planning.
- Communicates with health benefit plans, Insurer/payors for terms of health management and financial implications to physicians,, and patients and families as appropriate.
- Assists in management of payor denials; issues hospital-initiated notices of non-coverage (HINN’s)
- Defines desired clinical outcomes, sets target dates, and establishes a plan for required services and care, addressing all needs (i.e., physical, psycho-social, financial).
- Participates in IDT rounds
- Conducts utilization review, evaluates clinical information, and communicates findings to physicians and payors on a timely basis in accordance with the NFRMC Utilization Review Plan and managed care contractual agreements.
- Submits clinical information to insurance companies to ensure all days are authorized and notifies director of continued stay denials.
- Applies decision support criteria (e.g. Interqual) appropriately.
- Maintains accurate, up-to-date documentation in MIDAS.
- Assess patient/family clinical status needs related to medical diagnosis, treatment plan, treatment providers, treatment options, financial resources, and discharge planning needs.
- Interprets critical data and makes recommendations to effect improvement in outcomes based on trends in inappropriate, inefficient, or costly utilization.
- Intervenes to suggest creative options for inappropriate admissions.
- Documents case manager intervention and comparison to established criteria for medical necessity.
- Establishes ongoing dialogue with patient/family to determine if patient needs are being met.
- Monitors critical aspects of care affecting reimbursement.
- Assists staff with home care referrals.
- Provides point of contact for community physicians, staff, payers and patient regarding plan of care and questions related to discharge and resource utilization.
- Develops collaborative relationships with home care agencies or post-acute facilities.
Requirements:
- Registered Nurse-with Acute Care Experience
- BSN Preferred but not required
- Experienced acute care Case Manager experience
- Advanced EMR EPIC Documentation skills
- Will consider RNs with 3 years of ICU experience or strong Med-Surg experience and medical necessity skills.
- CCM- Certification in Case Management, or UR Utilization Review is preferred
- Interqual or similar experience
- RN unrestricted license required or obtain FL license within 60 days of start date.
- BLS-AHA
What does your day look like?: You will be working with patients on care coordination and progressing them through the continuum of care The RN Case Manager must like to communicate and be clear on communication, good with multitasking, and has the ability to pivot and adapt often
Case load can range from 30-45 cases Salary Range: $70-88K-depending on experience – Ask about the Sign-On Bonus
Full Time: 8-4:30 or 11AM-7:30PM
Benefits
A total rewards package that supports the health, life, career and retirement The available plans and programs include:
- Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
- Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
- Free counseling services and resources for emotional, physical and financial wellbeing
- 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
- Employee Stock Purchase Plan with 10% off the Healthcare stock
- Family support through fertility and family building benefits with Progyny and adoption assistance.
- Referral services for child, elder and pet care, home and auto repair, event planning and more
- Consumer discounts through Abenity and Consumer Discounts
- Retirement readiness, rollover assistance services and preferred banking partnerships
- Education assistance (tuition, student loan, certification support, dependent scholarships)
- Colleague recognition program
- Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
- Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
INDI
Krisha Morander-Email: KrishaM@jmorrissey.com
North Central Florida Location
Meet Your Recruiter
Krisha Morander, CPC
Vice President, Healthcare & Information Technology
Krisha's journey in the professional world has been nothing short of remarkable. Starting her career after completing her college education, she ventured into the realms of Commercial Art and Marketing, honing her creative and strategic skills. However, her path took a significant turn as she discovered her calling in the field of Recruitment.
Growing up in a close-knit, caring family where everyone played a vital role in supporting each other, including the care of elderly parents, Krisha's deep-rooted passion for healthcare began to flourish. She redirected her focus towards assisting job seekers in finding meaningful careers in healthcare that could make a genuine difference in the lives of others.
With an impressive 31-year career in the Staffing Industry, Krisha's expertise spans various domains. Initially, she dedicated herself to agency firm work, with a primary focus on healthcare and marketing communications. Her journey took a pivotal turn in 2004 when she joined J Morrissey. Here, she embraced Direct Hire Healthcare recruitment as her specialization.
In 2010, Krisha's entrepreneurial spirit led her to create the Information Technology division within the organization. Her dedication and exceptional performance in this role earned her the prestigious title of Vice President. She continues to pursue her passion for recruiting top-tier talent and nurturing new client relationships. Krisha also takes an active role in training and mentoring new staff, instilling in them the best practices and the art of meaningful interviewing.
Krisha's Direct Hire Recruitment Specialties encompass both Healthcare, spanning clinical and non-clinical roles, and Information Technology, from junior-level positions to the highest echelons of C-Suite leadership.
Outside of her illustrious career, Krisha finds solace and inspiration in the world of watercolor painting. Her creative spirit knows no bounds.
In her personal life, Krisha shares a blissful marriage of 36 years, a testament to her commitment and enduring love. Together with her loving partner, she is proud to be the parent of two wonderful children, completing her fulfilling life journey.