Hospital Case Management
Riverton Memorial Hospital - Riverton, WY

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The Hospital 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 PHI model. Communicates with physician, payers and other health care providers to ensure quality of 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.

Bachelor of Science Degree in Nursing or equivalent experience
Current RN licensure from the State of Wyoming
Current BLS certification
Minimum 3 years acute care experience required, ICU preferred
Demonstrate effective written and verbal communication skills
Proficiency with PC word processor and spread sheet programs
Knowledgeable of the principles of process improvement including data collection, analysis and reporting
Commission for Case Management Certification (CCMC) preferred
Demonstrates the ability to organize and prioritize
Possess knowledge of utilization management and reimbursement mechanisms
Possess thorough understanding of Protected Health Information (PHI) associated with Health Insurance Portability and Accountability Act (HIPPA)

Riverton Memorial Hospital - 18 months ago - save job - copy to clipboard
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