RN Case Manager

USPI South Texas Specialty Hospital is seeking a motivated RN Case Manager to join our team. We have 25 Beds and 8 OR rooms and 3 ER Rooms. We perform outpatient surgical procedures in Orthopedic, Spine.

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

What We Offer
As an organization, one way we care for our communities and each other is by providing a comprehensive benefits package that includes the following, subject to employment status:

• Medical, dental, vision, and prescription coverage
• Life and AD&D coverage
• Availability of short- and long-term disability
• Flexible financial benefits including FSAs and HSAs
• 401(k) and access to retirement planning
• Paid holidays and vacation

Who We Are
At USPI, we create relationships that create better care. We partner with physicians and healthcare systems to provide first-class ambulatory solutions throughout the United States. We are committed to providing surgical services in the most efficient and clinically excellent manner.

USPI is committed to, and proud of our inclusive culture. An inclusive culture, in our view, is respectful of differences and nurtures and supports the contributions of each individual, while also embracing and leveraging diversity. A diverse workforce, combined with an inclusive culture, makes USPI stronger and better able to meet the needs of our diverse patient and physician population.

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Qualifications: