![]() ![]() Software/Hardware: Strong knowledge in Microsoft Office applications – Word, Excel, Access, PowerPoint.Certification/Licensure: RN license required Certification in Case Management (CCM) strongly preferred.Experience (Type & Length): Three to five years of acute medical/surgical experience plus three to five years of Case Management experience.Education: Bachelor’s degree required Master’s degree preferred.Has the maturity to work independently and remotely.ĮDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:.Understand CMI, patient status, InterQual Criteria, Milliman Criteria, and Transfer DRGs.Must master Microsoft Office Products, i.e.Ability to work in a stressful, fast paced environment.Ability to effectively interact with insurance companies and community healthcare recourses.Demonstrates initiative and proactive approach to problem resolution.Leadership skills required for role include effective mentoring, coaching, counseling, time management, problem solving, and strategic planning.Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance carrier’s coverage details. Can be expected to do presentations as directed.Ability to read and communicate effectively in English. Adaptability to change and good organizational skills required.Ability to work competently with computer-based charting and other clinical and non-clinical software programs.Identifies and plans strategies to optimize inpatient length of stay and resource utilization.Communicates with payers to obtain authorization.Collaborates with the multidisciplinary team to assist patient with benefits management.Assesses the medical appropriateness, quality, and cost-effectiveness of proposed hospital, medical, and surgical services.The Care Manager works collaboratively with all healthcare disciplines to assure appropriate and timely services.Works within regulatory compliance guidelines. Supports Steward Health Care's and hospital goals and objectives.Assists in the development of physician profiles to identify over/under utilization patterns.Utilizes a complete and systematic methodology/process to assess, plan, implement, evaluate and provide patient care coordination from pre-hospital through post-hospital care. ![]() Collaborates and coordinates with other allied health professionals to ensure quality care is provided and desired outcomes are achieved in a timely and cost-effective manner. Assures clinical information is sent to the payor timely to complete the authorization of the patient stay. Communicates with the physicians and clinicians. ![]() The Care Manager assumes primary responsibility for documentation of appropriate medical necessity for the inpatient status or placement in observation. ![]()
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