Registered Nurse (RN) Case Manager
Location: Round Rock
Posted on: May 18, 2019
Description SHIFT: No Weekends
St. Davids Round Rock Medical Center is part of St. Davids
HealthCare , one of the largest health systems in Texas, which was
recognized with a Malcolm Baldrige National Quality Award in 2014.
With 171 beds, the hospitals comprehensive services include
advanced cardiac care at the Heart Hospital of Austin at St.
David's Round Rockthe first specialized cardiac facility in
Williamson Countywith the only Hybrid Operating Room (OR) in the
county; as well as emergency services in a 24-hour emergency
department, including advanced trauma care with a Level II Trauma
Center; St. David's Urgent Care Round Rock; and St. David's
Emergency Center in Cedar Park. St. Davids Round Rock Medical
Center is also known for providing advanced orthopedic and robotic
services, among other complex specialties. In 2016, the hospital
received the Distinguished Hospital Award for Clinical Excellence
from Healthgrades and also earned a national distinction for
patient safety from The Leapfrog Group . POSITION SUMMARY The Case
Manager is responsible for the identification of high-risk
patients, which require assessment and follow-through to accomplish
the goal of high quality and cost effective patient outcomes.
ESSENTIAL JOB RESPONSIBILITIES Financial Planning and Coordination
- Works cooperatively with Admissions Office and Business
services to facilitate and ensure proper assignment of
accommodation status for hospitalized patients.
- Monitors admissions to communicate patient information
regarding policy coverage, limits required documentation and other
relevant financial characteristics of coverage to appropriate staff
and medical providers.
- Ensures required documentation and justification is provided to
third party payers to obtain certification and rectification of
- Serves as a liaison between interdisciplinary care team and
funding sources, maintaining contact as required to report patients
status, progress, required treatments, and estimated length of
- Works with the patient and family to identify financial
resources available to them in the provision of necessary services
either inpatient or post discharge.
- Provides routine reports on effective utilization of case
management services related to cost containment and interventions
resulting in a more positive outcome with patient family, funding
source or other involved parties. Treatment Planning and
- Participate in the assessment of patient clinical and
psychosocial needs through review of patient information, personal
contact with the patient and family and interdisciplinary care team
- Serves as a liaison between members of the interdisciplinary
care team, funding source, patient, family, and outside case
managers to ensure treatment is met within quality standards and is
in line with insurance/funding parameters.
- Schedules and coordinates patient care conferences as
- Works cooperatively with members of interdisciplinary care team
in the development, implementation, and review of the care
management plan, in the coordination of patient service delivery,
and in the concurrently clinical review process.
- Communicates routinely with the patient, family,
interdisciplinary care team members, outside case managers and
other appropriate parties with regard to the status of patient
treatment plan and progress toward treatment goals, identification
of concerns and/or problems, problem solving, and assisting the
conflict resolution when necessary. Discharge Planning and
Continuity of Care
- Collaborates with interdisciplinary care team, patient and
family in the assessment and coordination of discharge planning
needs, delivery of post-discharge services and transition of the
patient along the care continuum.
- Collaborate with the other care team members to assess the need
for social service interventions for complex social issues.
- Documents discharge planning activities in the patients chart.
- Reviews admissions for appropriateness of admission using
- Provides for continued stay reviews for patients, which meet
the case management criteria, reviewing for intensity of service
and meeting of discharge screens using Interqual standards.
- Reports findings that do not meet Interqual standards to the
attending physician, Case Management Director, Medical Director and
the Utilization Committee.
- Tracks and trends cases not meeting Interqual standards.
- Assists with the denial and appeal process of medical necessity
denials. General Duties
- Works cooperatively as a team with other Case Managers, Social
Services, and interdisciplinary team members.
- Attends and participates in St Davids Partnership committees
and community committees. Other Duties as Assigned ...
Keywords: HCA., Austin , Registered Nurse (RN) Case Manager, Executive , Round Rock, Texas
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