Comprehensively plans for Case Management of a targeted patient population. Holds joint accountability with social worker for facilitating psychosocial and continuing care. Work with the physicians and multidisciplinary care team to facilitate efficient, quality care and achievement of desired treatment outcomes. Communicate clinical information to payers to ensure reimbursement. Collaborates with Performance Improvement to collect and analyze patient care and fiscal data related to target case types.PATIENT AGE GROUPS SERVED*Neonate, Pediatric, Adolescent, Adult, Geriatric* Varies by assignmentDUTIES AND RESPONSIBILITIES1) Assesses the total picture of every patient through patient/family, physical assessment as indicated, and review of the Medical Record including H&P, lab and other test results/findings, plans of care, physician orders, nursing and progress notes to identify needs and develop a plan. 2) Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization and continued stay; documents findings based on standards on UR Worksheet. 3) Works collaboratively and maintains active communication with physicians, nursing and other members of the multidisciplinary care team to effect timely patient management, addresses and resolves process problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge. 4) Identifies barriers affecting timely patient management and documents avoidable days. 5) Facilitate communication with payers and external Case managers by documenting days certified proactively and concurrently resolving any denied days or delays.6) Assist physicians, care providers, and patient/family in understanding payer plans / benefits and working within patients payer plans in order to maximize patients benefits and minimize out of pocket expense for patients.7) Discharge planning for assigned patients in collaboration with the social worker.8) Demonstrates the components of the I CARE values statement (Integrity, Compassion, Accountability, Respect, Excellence).9) Demonstrates ServicePRIDE standards ( Smile and make eye contact; greet each patient and visitor; seek out patient and visitor contact; displays appropriate body language at all times; take 5 minutes each day to go above and beyond for one patient or visitor; honor diversity; thanks every customer.)10) Follows all safety rules while on the job. Reports accidents promptly and corrects minor safety hazards.11) Perform other duties as assigned. EDUCATION REQUIREMENTSDiploma or Associate degree in nursing; BSN preferredEXPERIENCE REQUIREMENTS3-5 years clinical experience in direct patient care setting Prefer 2-5 years Case Management experienceCERTIFICATES, LICENSES AND REGISTRATIONS REQUIREDRN license in the State of TexasSPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIREDCritical thinking, advanced communication, negotiation and collaboration skills.