Case Manager RN - PRN

OrthoIndy Northwest; Indianapolis (IN); On-site; USD 60,000 - 90,000; Full time

Job summary

OrthoIndy Hospital MAIN in Indianapolis, IN is seeking a Case Manager in the OIH Case Management department. This PRN position supports weekdays with one weekend on-call every six weeks, requiring a minimum of three shifts per six weeks.

You will conduct psychosocial assessments, coordinate discharge planning, arrange post-hospital services, and work with payer sources to verify benefits and expedite reimbursement, while ensuring Medicare and payer requirements are met.

Qualifications

• Associate's Degree in Nursing required; Bachelor of Science in Nursing preferred.
• 1-2 years clinical experience in an acute care hospital environment, surgical center, or rehabilitation setting required; 2-4 preferred.
• Registered Nurse license required; Certified Case Manager preferred.

Responsibilities

• Initiate discharge planning with patient and family.
• Perform psychosocial assessment and identify support resources.
• Arrange post-hospital services with treatment team.
• Liaise with payer sources to review benefits and authorize services.
• Document payer contacts, authorizations, and days approved.
• Coordinate with admissions, billing, medical records and auditing to facilitate reimbursement.
• Review status and progress toward goals with treatment team and physician.
• Monitor financial resources and service scope for cost effectiveness.

Skills

Discharge planning

Payer liaison

Clinical assessment

Documentation

Education

Associate's Degree in Nursing

BSN preferred

Job description

Facility: OrthoIndy Hospital MAIN, Indianapolis, IN

Department: OIH Case Management

Shift Details: PRN weekdays with one weekend of on-call per six week schedule (Saturday and Sunday). PRN requirement is a minimum of three shifts per six weeks. Eligibility to participate in our 401K program with generous match after 90 days of service!

Responsibilities

• Makes contact with family or patient representative and performs introductory function and initiates discharge planning. Performs psychosocial assessment to determine pre-morbid history, human supports and available financial and community resources, cultural characteristics and interests, what the patient and family expectations for discharge.
• In conjunction with the patient, family and treatment team arranges post hospital services such as home care or rehabilitation placement.
• Promotes compliance with Medicare and payer source requirements. Responsible for contacting payer source to review accuracy of information, providing clinical update and discharge information as indicated by the payer source. Functions as liaison with payer representatives to manage financial resources, including verification of benefits for this and future settings Advocates with the payer on behalf of the patient to obtain needed services.
• Documents payer source contact, including authorization, contacts, and days approved. Works in conjunction with admissions, billing, medical records, coding, and auditing to facilitate reimbursement.
• Reviews medical documentation. Ensures completeness and accuracy of information, including appropriate admission orders.
• Provides patient and family with overview of his/her rehabilitation program, and works in conjunction with the patient and treatment team to determine treatment goals and estimated length of time for completion.
• Determines available financial resources and directs team planning to ensure conservation of funds and appropriate scope, intensity and duration of service delivery.
• Works with the physician to determine and maintain appropriate patient status. Responsible for contacting the attending physician to request clarification of documentation or continued stay review questions. Responsible for informing Admissions and other departments of changes in patient status.
• Reviews status, goals, and outcome barriers with the patient and treatment team and physician, monitors and facilitates progress towards goals. Ensures scope and intensity of services, financial coverage and alternative resources are appropriate to patient needs.
• Reviews and monitors treatment plan and use of treatment resources, collaborates with treatment team and physician to determine cost effective means of obtaining an optimal patient outcome.

Requirements

• Associate's Degree in Nursing required; Bachelor of Science in Nursing preferred from a nationally accredited nursing program.
• 1-2 years clinical experience in an acute care hospital environment, surgical center, or rehabilitation setting required; 2-4 preferred.
• Registered Nurse license required; Certified Case Manager preferred.

OrthoIndy is an Equal Opportunity Employer