About this opportunity
MLee Healthcare Staffing and Recruiting, Inc lists this Advanced Case Manager, RN Preferred opportunity in milton, Louisiana. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Advanced Case Manager
Milton, LA $57,007 - $72,009 a year
Full Time
We are seeking a dedicated Advanced Case Manager to join our healthcare team in a regional setting within the Southern United States. This role involves comprehensive review and management of patient admissions, ensuring compliance with utilization management criteria, and coordinating care transitions effectively.
Responsibilities
Review physician orders, emergency documentation, and diagnostic tests to determine admission status using approved criteria.
Utilize Interqual tools for admission and concurrent reviews.
Collaborate with admissions and emergency staff to clarify patient status (in-patient vs observation).
Conduct admission, concurrent, and discharge reviews to obtain insurance authorizations and assign length of stay within designated timeframes.
Perform admission reviews and discharge screenings within 24 hours, identifying patients needing comprehensive discharge planning.
Maintain familiarity with patients' medical histories, hospitalization events, anticipated DRG, length of stay, and discharge plans.
Complete patient assessments within 72 hours, including interviews with patients, families, or caregivers, and review of prior records.
Evaluate and document patients' needs for post-hospital services, providing appropriate resource lists when applicable.
Coordinate post-discharge care arrangements such as home health, skilled nursing, rehab, hospice, and durable medical equipment.
Document interdisciplinary team communications and family involvement thoroughly.
Incorporate quality and resource measures aligned with patient goals in discharge planning.
Engage patients and families in continuity of care discussions to ensure agreement on discharge plans.
Manage communications including voicemail and emails promptly, handling insurance reviews and patient inquiries.
Participate in quality assurance activities including surveillance and data collection for trend analysis.
Consult social services as needed based on assessments or physician orders.
Maintain detailed documentation of authorizations, denials, readmissions, avoidable days, and discharge plans.
Identify high-risk patients and contribute to readmission reduction efforts by analyzing root causes and coordinating follow-up care.
Ensure telephone contact with patients within 72 hours post-discharge.
Attend daily reports and interdisciplinary team meetings to discuss patient status and discharge planning challenges.
Keep physicians informed of patient progress and collaborate on care goals.
Appeal insurance denials within required timeframes.
Coordinate discharge and transfer logistics, ensuring all clinical information and documentation are complete and accurate.
Stay updated on relevant laws, regulations, and guidelines such as those from Centers for Medicare and Medicaid Services.
Perform additional duties as assigned to support organizational mission and values.
Education & Experience
Preferred candidates will hold licensure as a Registered Nurse or Licensed Practical Nurse and have experience in case management or related clinical roles.
Licenses & Certifications
Advanced Cardiac Life Support (ACLS) preferred
Basic Life Support (BLS) required
Licensed Practical Nurse (LPN) or Registered Nurse (RN) licensure preferred
Worksite address
milton, LA, 70558, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.