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Inpatient Nurse Case Manager

Coordinates the delivery of healthcare and social services to the inpatient population while balancing individually identified patient and family, medical, and psychosocial needs with cost-effective and available resources. Manages the inpatient hospital stay of a caseload of patients through coordination with physicians, social workers, nursing staff, and other health professionals. Reports to the Nurse Manager of assigned unit.: Performs utilization review and collaborates with the care team to formulate the discharge plan. Implements a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for the patient to an appropriate lower level of care in collaboration with the hospitalist/physician member team, acute or skilled facility staff, ambulatory care team, and the patient and/or patient's representative from admission through discharge. Interfaces with physicians, nursing staff, and other members of the multidisciplinary and medical records coding staff to ensure appropriate reimbursement is received. Determines medical necessity for admission and continued stay according to specific criteria and regulations in accordance with the Utilization Review Plan. Conducts daily/concurrent reviews of charts to rectify any deviation from compliance. Educates staff, physicians, and other members of the multi-disciplinary team on documentation for compliance. Identifies consistent clinical and operational problem areas and facilitates resolutions through participation in the performance improvement process. Acts as liaison for the management and communication of information with the insurance/managed care companies of the assigned patient population.

Inpatient Nurse Supervisor

Supervises inpatient case management operations to ensure evaluation of medical necessity for inpatient hospitalization using appropriate application of criteria.: Coordinates activities related to inpatient admissions, ongoing concurrent review, discharge planning, processing of reviews and serving as a clinical resource. Monitors activities to ensure that daily requests for inpatient authorization are processed within appropriate timeframes and according to department standards and plan agreements. Prepares and submits inpatient reports. Monitors departmental activities to ensure that the utilization management and case management programs are observed. Makes rounds in area hospitals to monitor inpatient services. Maintains an accurate census. Hires, develops and motivates a qualified department staff. This position typically requires a Registered Nurse license with direct patient care experience. May require a Certified Case Manager (CCM) certification. May perform routine internal monitoring of staff activities to ensure quality.

Inpatient Nurse

Works with health plan enrollees, providers and caregivers to provide intensive case management and increase efficient utilization of services. This position typically requires Registered Nurse license with direct patient care experience. May require a Certified Case Manager (CCM) certification.: Works with health plan enrollees, providers and caregivers to provide intensive case management and increase efficient utilization of services. Identifies and locates hospitalized patients requiring review for medical necessity to verify that hospitalization is necessary. Travels to local hospitals and offices to conduct rounds on patients. Identifies chronic cases through the concurrent review process and initiates intensive case management. Performs onsite reviews and evaluates the medical necessity for inpatient hospital admission. Authorizes the admission along with the estimated length of stay and level of service required. Coordinates services to be provided after inpatient hospitalization. Initiates and coordinates discharge planning on inpatient enrollees. Screens for the medical necessity of outpatient procedures, home medical equipment, medications and any other service that requires pre-certification as part of discharge planning. This position typically requires Registered Nurse license with direct patient care experience. May require a Certified Case Manager (CCM) certification. May perform utilization management activities to include pre-certifications, admission reviews, concurrent reviews and retrospective authorizations. May assist in medical protocols studies

Coder Health Care

Compiles and maintains medical records of patients of health care delivery system to document patient condition and treatment. Reviews medical records for completeness and to abstract and code clinical data, such as diseases, operations, procedures, and therapies, using standard classification systems. : Compiles medical care and census data for statistical reports on types of diseases treated, surgery performed, and use of hospital beds, in response to inquiries from law firms, insurance companies, and government agencies. Maintains and utilizes variety of health record indexes and storage and retrieval systems. Operates computer to process, store, and retrieve health information. Assists Medical Records Administrator in special studies or research as needed. May code medical records for reimbursement purposes.



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