RN Case Manager (8A-4:30P)

Jackson County Hospital District; Marianna (FL); On-site; USD 70,000 - 90,000; Full time

Job summary

Jackson County Hospital District is seeking a skilled Case Manager to perform preadmission through retrospective reviews and manage discharge planning. You will ensure appropriate stays, coordinate with physicians, and guide patients and families toward suitable post-hospital care.

The role requires Florida RN licensure or equivalent social work experience, with 3–5 years in acute care and BLS certification. Knowledge of Medicare/Medicaid and payer criteria is essential.

Qualifications

• Current Florida RN license; or social worker with acute care hospital experience.
• 3–5 years in an acute care hospital setting.
• Experience with hospital case management preferred (1–2 years).
• Working knowledge of Medicare/Medicaid/HMO and private insurance coverage.
• BLS certification.

Responsibilities

• Perform preadmission, admission, continued stay, and retrospective reviews.
• Conduct timely and orderly reviews and keep observation tracking up to date.
• Verify appropriate use of care per InterQual criteria and payer rules.
• Collaborate with Case Management Director and Physician Advisor on discharges.
• Communicate discharge planning needs with physicians and families.
• Maintain knowledge of community resources and arrange post-hospital care.

Skills

InterQual criteria knowledge

Discharge planning

Communication with physicians

Education

Florida RN license

BLS certification

Job description

Description

• Able to perform preadmission, admission, continued stay, and retrospective reviews and observation tracking.
• Conducts reviews in a timely and orderly fashion.
• Has working knowledge of InterQual level of care criteria.
• Has working knowledge of Medicare, Medicaid, as well as Managed Care DRG assignment.
• Properly reviews private insurance as determined by pre-established contracts.
• Able to verify that all inappropriate admissions, unnecessary continued days, and procedures not meeting approved indications are given to the Case Manager Director for review by the Physician Advisor.
• Participates in process improvement activities aimed at improving utilization and compliance.
• Performs assessments on Medicare, Medicaid and high-risk patients to determine discharge planning needs, always documents assessments.
• Communicates with physician regarding discharge planning needs of the patient. Assists the physician to facilitate post-hospital care.
• Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed. Is able to obtain other resources as needed.
• Initiates ongoing communication with the patient and patient's family to assess discharge needs.
• Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.
• Documents discharge planning in an ongoing manner.
• Demonstrates knowledge of patients' financial status, diagnosis and discharge needs.
• Is responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known
• Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.
• Actively participates in discharge planning by working effectively with the Case Management team and other areas to promote early discharge planning.
• Provides support with Advanced Directives.
• Assists patient/family with the grieving process and makes referrals to Pastoral Care, as appropriate.
• Identifies need for referral to social worker and makes referrals as appropriate.
• Build and maintain solid relationships with providers. Effectively communicating successes and failures with them as appropriate
• Adheres to departmental policies, procedures, and objectives, and quality, safety, and infection control standards.
• Demonstrates competence in using the intranet to access policy and procedure documents
• Practices according to the policies and procedures outlined by the organization.
• Maintains and respects confidentiality of patient/physician/personnel information
• Participates actively in the maintenance of a safe environment for patients, visitors, and staff.
• Adheres to standard infection control guidelines
• Documentation meets current standards and policies.
• Maintains a good working relationship both within the department and with other departments
• Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
• Follows chain of command appropriately.

Requirements

• Regulatory Requirements:
• Current nurse licensure in the state of Florida, RN preferred; or social worker with acute care hospital experience
• Must have three to five years' experience in an acute care hospital setting. Prefer at least one to two years hospital case management experience or related experience.
• Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.+
• BLS