Responsibilities:
Coordinates/facilitates patient care progression throughout the continuum of care.
Assures the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
Communicates with payer the medical necessity for the status and LOC ordered to obtain authorization and reimbursement for care rendered.
Monitors length of stay and ancillary resource use on an ongoing basis and takes actions to achieve continuous improvement in both areas.
Communicates information to the Case Management team to aid in appropriate level of care determination and reimbursement by third party payors.
Communicates identified issues affecting quality of care, risk management, patient satisfaction and or physician opportunities to the quality team using the Improve the Process form.
Ensures that all payer communication is documented for the care team as well as billing.
Ability to cover various populations across the organization in relation to Utilization Review.
Performs all other duties as requested by Case Manager Supervisor and/or Director.
Qualifications:
1-2 years of recent acute care hospital experience required
Data entry/computer experience required.
Requirements:
Licenses and Certifications:
Registered Nurse
Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon and McLeod Behavioral Health.