Manages the care for a specific population; facilitates the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service delivery and compliance with federal and other payer requirements. Provides early assessment of transitional needs identified during their hospitalization, illness, and/or life situation. Performs other duties as assigned.Responsibilities
Requirements, Preferences and Experience Education
- Provides clinical review and utilization management for all payers utilizing criteria and other payer based tools.
- Maintains communication with patient and/or family on an ongoing basis. Communicates in person as often as necessary to maintain an agreed upon discharge plan of care.
- Collaborates with the health care team on an ongoing basis to promote a smooth and effective transition/discharge.
- Assists in monitoring of readmission rates and identifying opportunities for improvement.
- Provides timely information and coordination to reduce denial opportunities by payers.
- Completes assigned goals.
Preferred: Bachelor's in Nursing
Minimum: Diploma or Associate Degree in NursingExperience
Preferred: RN with 3 years of clinical experience with Case Management experience in a hospital or payer setting
Minimum: RN with 2 years of clinical experienceLicensure, Registration, Certification
Minimum: RNSpecial Skills
Preferred: Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.
Minimum: Critical thinking skills, communication, organization, interpersonal and computer skills. Knowledge of payer requirements; problem solving; and governmental regulations.Training
Preferred: 3 years of clinical experience with Case Management experience in a hospital or payer setting
Minimum: 2 years of clinical experienceAbout Baptist Memorial Health Care
At Baptist, we owe our success to our colleagues, who have both technical expertise and a compassionate attitude. Every day they carry out Christ's three-fold ministry-healing, preaching and teaching. And, we reward their efforts with compensation and benefits packages that are highly competitive in the Mid-South health care community. For two consecutive years, Baptist has won a Best in Benefits award for offering the best benefit plans compared with their peer groups. Winners are chosen based on plan designs, premiums and the results of a Benefits Benchmarking Survey.At Baptist, We Offer:
- Competitive salaries
- Paid vacation/time off
- Continuing education opportunities
- Generous retirement plan
- Health insurance, including dental and vision
- Sick leave
- Service awards
- Free parking
- Short-term disability
- Life insurance
- Health care and dependent care spending accounts
- Education assistance/continuing education
- Employee referral program
Position: 11343 - RN-Case Manager
Department: JS Senior Care Center MBMC
Category: Nurse RN
Work Type: Full Time
Work Schedule: Days
Located in the Jackson, MS metro area