RN Case Manager

USPI Foundation Surgical Hospital of San Antonio is seeking a motivated Case Manager to join our team. We have 20 private suites and 5 OR rooms. We perform outpatient surgical procedures in Bariatric, Orthopedic, General, Neuro/Spine, ENT, Pain, Urology. 

Job Summary: Facilitates progress through the continuum of care, from Pre-Admission through Discharge for Foundation Surgical Hospital; Provides feedback to payors on patient’s clinical status and secures approvals for additional days of stay; Monitors quality standards as determined by the Performance Improvement Plan and the Medical Staff Quality Indicators; Evaluates patients for discharge planning needs and appropriately directs the patient’s care; Monitors resource consumption for most effective use; Identifies teaching and psychosocial concerns for the best patient outcomes; assists in aggregating data for quality trending; assists in Infection Control surveillance; functions as a Patient Advocate to assist patients in resolving concerns.

Duties and Responsibilities

• Completes discharge planning assessment within 24 hours of admission
• Arrange/Coordinate all post-acute care services and equipment in timely manner to provide safe appropriate level of care and supplies upon discharge
• Compliance with CMS regulations for issuance of IMM, MOON, HINN, DND, ABN, Choice forms and all other discharge planning tasks as assigned
• Maintain HIPPA compliance
• Complete and or maintain working knowledge of daily Utilization Review tasks in accordance with hospital policy and Interqual guidelines to include prospective, admission, concurrent, retrospective reviews; correct admission status; avoidable days; medical necessity; continued stay criteria; LOS; Coding and DRG criteria; discharge readiness.
• Correspondence with interdisciplinary team, physicians, payers, and physician office staff to maintain cost effective and timely coordination of care throughout hospital stay
• Provide clinical documentation and requested information to payors in accordance with, but not limited to, appropriate admission status, clinical updates, admission/discharge notifications, post-acute care referrals and pre-authorization requests
• Timely documentation in EHR
• Serves as a departmental resource for auxiliary departments and staff
• All other duties as assigned

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Qualifications: 

• Graduate of an accredited school of nursing, BSN preferred
• Current, active Texas RN licensure required
• BLS required
• Case Management certification preferred, but not required
• Minimum two (2) years acute care experience required
• Previous case management experience preferred
• Ability to work independently
• Working knowledge of Microsoft Word and Excel preferred;
• Willingness to learn computer applications necessary for work functions;
• Ability to adapt to changing situations and various personalities with a positive attitude.
• Ability to utilize Electronic Heath Care Record for patient documentation.
• Adheres to strictest confidentiality in dealing with patients, families, hospital personnel and the public