Access Case Manager

The Access Case Manager evaluates the medical necessity for admission, status and appropriateness of patient care unit placement for all scheduled admissions, direct admits, transfers, and outpatient conversions and provides consultation to physicians prior to patient placement.  The Access Case Manager will coordinate any unexpected discharge planning needs for this patient population that are not transitioned to the inpatient case manager so that a smooth transition from the acute outpatient care setting to the community setting is ensured and readmission is averted. Refers to Social Work those patients with complex psychosocial or discharge planning needs and follows-up to ensure appropriate intervention.  

Acts as a resource to ensure appropriate reimbursement for all scheduled procedures. 

Dialogues with the payers as necessary to guarantee appropriate reimbursement for outpatients and scheduled admissions.  Communicates with physicians and other members of the interdisciplinary healthcare team to ensure implementation of clinical practice guidelines or standing orders to meet expected standards of care for patients.   Provides support and information to patients/families with identified financial or psychosocial needs. Serves as the liaison for the other members of the interdisciplinary team to ensure appropriate and expedient referrals upon decision to admit to the acute care inpatient setting

:

Organization, analytical, writing, and interpersonal skills.

Dependable, self-directed, and pleasant.

Critical thinking, problem solving and deductive reasoning skills.

Recent hospital experience preferably ICU, CCU, or strong minimum 3 years Med/Surg. Experience.

Knowledge of Pathophysiology and Disease Process.

Knowledge of Medicare, Medicaid, Managed Care Health Plans.

Experience in Hospital Case Management preferred.

:

1.      Bachelor’s Degree in Nursing, medicine, or related field.

2.      Certification in Case Management preferred or obtained certification in Case Management within two years of hire.

3.      Current American Heart Association BLS required.