RN Clinical Case Manager
Job Title: RN Clinical Case Manager
Job Category: Nursing
Hours per Shift: 8
Shift Start Time: 8:00 am
Shift End Time: 4:30 pm
Company: Wheaton Franciscan- St. Joseph Campus
Department: Care Management
Location: WFH-St. Joseph 5000
Licensed in the State of Wisconsin as a Registered Nurse BSN preferred. The Clinical Case Manager must have excellent verbal & written skills, as well as, skilled knowledge of disease processes with a varied patient population. 3 years experience as a Case Manager, utilization review or quality/ performance improvement staff required with knowledge of acute hospital care screening criteria such as Milliman Care Guidelines or Interqual Criteria. Experience within a health care system highly desirable. In addition to the concurrent UR/Care Coordination role, RN Case Manager facilitates timely patient discharges.
This is a float associate with potential Case Management staffing assignments at St Joseph. Elmbrook Memorial or The Wisconsin Heart Hospitals
The Clinical Case Manager
Assesses and ensures that all patients admitted to the hospital meet acute care criteria, and that each patient moves along the health care continuum.
Completes Medical Necessity reviews on assigned patients, and Continued Stay Reviews as defined by the Utilization Management Plan.
Assesses assigned patient medical record to ensure correct documentation of patient admission status.
Facilitates open and effective communication with the multidisciplinary health care team and physicians to ensure continuation of the patient's health care plan in the most appropriate clinical setting.
Ensures compliance of fiscal responsibility by obtaining payor authorization/certification upon admission and continued stay.
Applies high risk screen on all admissions in order to initiate discharge planning, social work referral and/or continue to monitor for discharge planning needs.
Develops preliminary discharge plan and anticipated discharge date with physician, patient/family/designated spokesperson and works with the interdisciplinary team to anticipate discharge, coordinate the plan in a timely and efficient manner.
Identifies and trends barriers to discharge and refers unresolved issues to the Director and or Physician Advisor.
Other responsibilities as assigned by the Department Director.