Job Information
North Texas Medical Center RN Case Manager in GAINESVILLE, Texas
JOB SUMMARY
The Case Manager functions as the primary liaison between North Texas Medical Center, patients treated in the Emergency Department, the Intensive Care Unit, the Womens Center unit and families, the physician, the payer, community partners and all other related parties to ensure appropriate level of care by comprehensive review of medical necessity of outpatient observation and inpatient stays. The position champions placement of the patient in the right status with appropriate and efficient resource utilization.
SUMMARY OF ESSENTIAL JOB FUNCTIONS
Reviews admissions and continued stays, determining the necessity and appropriateness of hospitalization, using approved criteria.
Maintains appropriate charting and reviews medical records for documentation completeness. Communicates with physicians to obtain orders for post-hospital care or additional documentation when screening criteria is not met for inpatient treatment.
Collaborates with attending physician to define appropriate level of care and service that best meet the patients needs.
Maintains appropriate documentation to include specific utilization review activities, maintaining confidentiality for patients and their families.
Refers cases not meeting criteria to the Contracted Reviewer for determination of appropriate status.
Communicates appropriate review information to HMOs, PPOs, and other third-party payers to certify patients for their hospital stay and services rendered.
Monitors indicators such as length of stay, observation rates, delays in services, resource utilization, quality and satisfaction outcomes for individual stays and patient populations. Works collaboratively with patient health care team to identify opportunities for improvement and implement best practice solutions.
Stays up to date on industry best practices and maintains a network of professionals to exchange ideas and benchmark best practices.
Routinely assists other team members as needed. Works in various units or campuses in North Texas Medical Center to meet patient needs.
This position performs other duties as assigned.
SPECIFIC DAILY RESPONSIBILITIES
Review Medhost, census information and discharge reports.