Case Manager (RN or Social Worker) - Safety Sensitive
Company: White River Health
Posted on: November 18, 2023
The case manager will facilitate modifications to clinical
documentation via physician clarity or addendum, through extensive
concurrent interactions with physicians and other clinicians in
order to reflect appropriate clinical severity, complications and
The specialist shall concurrently review and evaluate selected
patient's medical records for overall quality and completeness. The
case managers role is to ensure that health care services are
administered with quality, cost efficiency, and within
- Consistently complies with the guidelines set forth by
- Reviews medical records of hospitalized patients to identify
the most appropriate principle diagnosis and assign a working
- Performs review to ensure medical necessity of hospitalization
and ensure DRG accurately reflects the principal diagnosis and all
comorbid conditions, after study.
- Educates IDT on clinical documentation and coding
- Develops and conducts ongoing CDI education for members of the
- Utilizes a compliant query process per guidelines and policy
when conducting all queries.
- UR/CDI will support and implement quality measures as
identified by department manager.
- UR/CDI will help identify opportunities for performance
- Identifies actual and potential delays in service request or
treatment and communicates them to health care team so steps can be
taken to eliminate or minimize delays.
- UR/CDI nurse will utilize condition code 44 guidelines when
- UR/CDI nurse will perform admission, concurrent, and discharge
reviews using Milliman Care Guidelines to facilitate medical
- UR/CDI nurse will send clinical information to payers as
- UR/CDI nurse will facilitate peer to peer reviews for inpatient
medical necessity denials with attending physician.
- UR/CDI nurse will monitors all patients for medical necessity
taking necessary action to include issuing ABN's or HINN's and
- Performs other duties as assigned by supervision.
- Education: --- RN or Social Worker licensure required.
--- BLS required.
- Training and Experience: --- 3-5 years clinical experience
- Job Knowledge: --- Knowledge of Conditions of Participation for
--- Knowledge of compliant query practices.
--- Demonstration of effective problem-solving techniques including
conflict management skills
--- Demonstration of excellent oral and written communication
--- Excellent organizational and record-keeping skills, as well as
the ability to manage multiple cases
--- Completes responsibilities in a timely manner through effective
organization, setting priorities, delegation, and time management
--- Maintains integrity, confidentiality, and ensures compliance
with WRMC's policies and procedures, regulatory and legal
requirements and current health care standards.
- Must be able to report to work fit for duty and free of any
adverse effects of illegal drugs, medical marijuana, prescription
medication, and/or alcohol.
- Must be able to effectively communicate both orally and in
writing with other individuals.
Physical Demands: Job responsibilities require a considerable
amount of physical work. The individual will be required to assist
with lifting and moving patients, pushing of carts, wheelchairs,
and other equipment; and lifting or pushing of up to 50 pounds. The
individual must be able to bend over to perform certain duties,
e.g.., check chest tube drainage, check urinary output, etc. The
individual must also be able to maneuver throughout the halls,
stairways, and patient rooms in response to hospital emergencies.
Interpretation of environmental input requires visual and auditory
skills. A significant amount of writing and computer entry is
Keywords: White River Health, Jonesboro , Case Manager (RN or Social Worker) - Safety Sensitive, Executive , Batesville, Arkansas
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