This position is responsible for the coordination of care for the patient and their support systems. Collaborations with physicians, social work, nursing, and all disciplines of care are crucial in determining not only appropriateness of care, but also the continuum of care, discharge planning, and post discharge/transfer. A working knowledge of resource contacts for continued care is also pertinent. Clinical outcomes management and monitoring is also an element of this position. This position is also responsible for the concurrent review and data abstraction of the medical record. Patients are assessed for clinical documentation reflecting continuum of care and medical necessity according to criteria established by TMF, Medicare, Medicaid, Managed Care agencies, and Clinical Path resources [Interqual, M&R]. Such criteria are used only as a guide in determining medical necessity for continued stay for individualized patients. Demonstrates mastery and competence in computer skills. Demonstrates knowledge of disease processes, normal vs. abnormal clinical findings, and usual and customary healthcare treatment. Demonstrates excellent communication skills and quality management skills. Participates as a member of the inter-disciplinary healthcare team.
- TX RN license
- Current CPR
- BSN required
- Knowledge of Medicare, Medicaid, TMF, TDH, M&R, Interqual criteria.
- Minimum of 3 - 5 years acute care experience in a clinical area of expertise.
- Experience in Case management preferred
- 6 months hospital bedside nursing experience required
- Case Management preferred
- Proficient in Windows, Word, Excel
- Proficient in keyboarding & mouse use, Fax machine operations, Copier, Printer
- Basic nursing skills [see checklist]
- Disease Management knowledge
- Critical thinking skills / judgments
- Customer service communications