The Case Manager is responsible for facilitating appropriate health care services throughout the continuum of care. Uses collaborative and systematic processes to assess, plan and coordinate the implementation of services that meet the individual's health needs.
Collects and utilizes data to monitor and evaluate the appropriateness and effectiveness of those services in accordance with the organizations PI model. Communicates with physician, payers and other health care providers to ensure quality care and promote fiscal responsibility through the appropriate utilization of resources. In the absence of a dedicated Clinical Documentation Specialist the Case Manager utilizes advanced knowledge and clinical expertise to direct the health care providers towards the improvement of clinical documentation.
Facilitates the overall quality, completeness and accuracy of the medical record. Through extensive interaction with physicians, nurses and other care givers, achieves appropriate documentation to support the medical necessity and level of services rendered to all patients. Assist with the ongoing development and delivery of education on documentation guidelines, coding and reimbursement rules for all members of the patient care team. Provides services to patients throughout the lifespan including newborns, children, adolescents, adults and geriatric age groups.
Minimum Education: Graduate of a School of Nursing Program.
Minimum Experience: At least 3 years of Utilization and case management experience strongly preferred. Ability to prepare reports and formal presentations preferred.
Certification/Licensure: Current New Mexico or compact RN licensure required.
Certification by the National Association of Healthcare Professionals or InterQual is desirable. Certification as a CCM or ACM desired.