Registered Nurse (R)N-Pediatric Rehab Case Manager, Full-Time, Days

Inspire health. Serve with compassion. Be the difference.

Job Summary

Performs activities and duties related to preadmission assessment screening and admission of patients to the Pediatric Inpatient Rehabilitation Unit. Serves as Case Management resource for patients and family members. Assesses patient progress with rehabilitation plan of care and partners with Pediatric Inpatient Rehabilitation leadership and therapy team members to promote the rehabilitation process for each patient. Provides expert guidance on regulatory and compliance concerns for Case Management. Performs discharge planning activities for patients, and proactively identifies and resolves obstacles of patient rehabilitation, monitoring the documentation of patient medical records.

Essential Functions

All team members are expected to be knowledgeable and compliant with Prisma Health's values : Inspire health. Serve with compassion. Be the difference.

Conducts insurance and pre-admission screenings, as well as clinical assessments, to ensure that patients qualify for rehabilitation admission and insurance / payer reimbursement. Facilitates the smooth transition of patients into the Pediatric Inpatient Rehabilitation Unit by coordinating transportation and receiving times and dates. Educates patients, family members, referral sources, and external payers regarding the effective and efficient utilization of program services and available resources.

Serves as Case Management resource for patients and families with regard to their rights and responsibilities, when payment of care is denied or when acute rehabilitative care is no longer necessary. This include, but is not limited to, delivery of regulatory documents as provided by CMS. On the basis of preliminary risk screening, assesses patients' and families' psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness, and ability to cope.

Performs discharge planning activities for patients with complex medical issues, in order to ensure a timely discharge and to provide appropriate linkage with post-acute rehabilitation care providers. Addresses and resolves system problems impeding rehabilitation progress. Proactively identifies and resolves delays and obstacles during the rehabilitation discharge planning process. Monitors patient progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient and family-focused, high quality, efficient, and cost effective.

Partners with Pediatric Inpatient Rehabilitation Center leadership and Prisma Health Marketing and Communications to promote the rehabilitation services by conducting phone calls and site visits to screen potential children and young adults for admission while also promoting awareness of services. Develops relationships with referral sources.

Assists the Pediatric Inpatient Rehabilitation team in the development, maintenance, evaluation, and interpretation of clinical data pertaining to admissions and discharges on the Pediatric Inpatient Unit.

Attends and facilitates weekly Inpatient Pediatric Rehabilitation Case Conferences and Family meetings, discussing individual patient progress with rehabilitation, and coordinates the documentation of meetings.

Participates with Pediatric Inpatient Rehabilitation Center team in the completion and monitoring of compliance guidelines for the Commission on Accreditation of Rehabilitation Facilities and the Joint Commission.

Provides expert guidance and assistance to Pediatric Inpatient Rehabilitation Center clinical staff on regulatory and compliance concerns for Case Management and Utilization Management.

Monitors the medical record documentation of patients to ensure quality and accuracy.

Performs other duties as assigned.

Supervisory / Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

Education - Bachelors degree in nursing

Experience - Three (3) years acute care nursing experience. One (1) year acute care / case management experience preferred.

In Lieu Of

In lieu of the BSN requirement above, a nursing diploma or an Associate degree in Nursing may be considered if the applicant signs a BSN Memorandum of Understanding (MOU) agreeing to enroll in an accredited BSN or MSN program within one year and obtain a BSN or MSN degree within (4) four years of hire date. Further, employees must demonstrate sufficient progress annually toward obtaining an accredited BSN or MSN degree to remain eligible for employment or may be terminated. - Required

Required Certifications, Registrations, Licenses

RN Currently licensed in South Carolina

BLS

A valid driver's license; an acceptable motor vehicle record, as defined by the Acceptable Motor Vehicle Record (MVR) Chart; and proof of auto insurance.

Knowledge, Skills and Abilities

Expertise in analysis

Decision-making skills

Time management skills

Communication skills

Computer skills

Assessment skills

Ability to function independently

Knowledge of insurance and managed care principles and practices - preferred

Knowledge of regulations of agencies involved in program operation and resources available for use in assessing regulations and parameters of third-party reimbursement - preferred

Work Shift

Day (United States of America)

Location

7 Medical Park Rd Richland

Facility

1510 Richland Hospital

Department

15107517 Hospital Case Management

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