Interqual Jobs in Tennessee (NOW HIRING)

Case Manager

Case Managers will apply systems, science, incentives, and information to improve healthcare practice and assist patients and their support systems to become engaged in a collaborative process designed to manage medical/social/mental health conditions more effectively. The case manager's objective is to achieve an optimal level of wellness for patients and improve coordination of care while providing cost effective, non-duplicative services. Performs all other duties as assigned.

Responsibilities:

• Assess and document the clinical, psychosocial and financial needs of patients including availability of care support, risk for readmission and safe environment upon discharge/transition and payor benefits. Findings are collected by interviewing patients, caregivers and members of the interdisciplinary team. Aspects of this assessment obtained from the patient record or previous case manager assessment are validated, updated and influence the plan of care. Assess and document the patient's care management and potential discharge needs. 20 %
• Apply InterQual to determine/validate Level of Service and Intensity of Care. Utilize InterQual criteria within the first 24 hours of arrival to complete an initial review. Collaborate with physicians, Manager of Case Management and physician advisors to resolve conflicts. Coordinate with bed control to attain proper placement. Perform concurrent reviews of medical records to ensure continued appropriateness and make recommendations based on the needs of the patient. Escalate and facilitate resolution of unjustifiable aspects of care that vary from InterQual guidelines. 20 %
• With the physician, identify the plan of care, estimated length of stay and transition/discharge plan. Meet with patients and families to engage them in the plan and obtain agreement. Incorporate all processes and procedures into the plan to ensure safe discharge/transition. Coordinate with physician and nurse to make plan adjustments as patient condition indicates. Use best practices and available pathways to anticipate the course of care through discharge/transition. Incorporate ancillary services as needed. Work in collaboration with social work for complex postacute placement and community service resources. 20 %
• In coordination with nursing, ancillary departments, social work, and the physician, monitor and ensure the treatment plan and steps to prepare for transition or discharge are completed as planned, gaps in care are avoided as well as duplicative or unnecessary services. 10 %
• Ensure that patients are discharged/transitioned timely and appropriately and that variances from the plan or target discharge/transition date are documented. 10 %
• Escalate concerns and barriers to appropriate treatment or transition as outlined by the department. 10 %
• Maintain a working knowledge of facilities and resources available to patients and caregivers. 10 %

Specifications:

Experience:

Minimum Required:

• 3 years Healthcare/Medical-Acute Care Required.

Preferred/Desired:

• Healthcare/Medical-Case Manager Preferred, or Healthcare/Medical - Utilization Review Preferred.

Education:

Minimum Required:

• Graduate of School of Nursing-Accredited Required.

Preferred/Desired:

• Bachelor's Degree Nursing Preferred, or Bachelor's Degree Allied Health Preferred.

Training:

Minimum Required:

Preferred/Desired:

Special Skills:

Minimum Required:

• Must be able to work with acutely & chronically ill patients of all ages and their caregivers. Must have excellent interpersonal communication, multi-tasking, prioritizing & organizational skills. Demonstrated ability to work effectively with teams in a collaborative manner and escalate issues appropriately. Ability to work weekends and flexible hours per the department staffing plan.

Licensure:

Minimum Required:

• License/Certification/Registries (valid for the State of MS): Registered Nurse (RN) by the State Board of Nursing Required.

Preferred/Desired:

• Certification by the Case Management Society of America Preferred, or Equivalent Certification Preferred.