Rn Hospital Case Manager Discharge Planner resume example

Assess and plan for discharge needs, placement; infusion; home health; snf; hospice; long term care;Utilization review per Interqual Criteria. Travel Assignment

1555 Soquel Dr., Santa Cruz, Ca; HOSPITAL CASE MANAGER/DISCHARGE PLANNER Assessment of discharge needs, plan admit to SNF, long term care, home care, home infusion, and hospice. Coordinate plan for discharge home, durable medical equipment, home infusion, skilled nursing facility, and hospice.

Assessment of patient discharge planning needs, placement for skilled nursing, custodial, long-term care, board and care facilities. Coordinate home health, hospice, palliative care, and transportation. Ordered durable medical equipment for patient discharge home and any other discharge planning needs. Travel assignment.

Precertification of all outpatient surgery and radiology/diagnostic testing per InterQual criteria and Medicare guidelines.

Admissions of clients health history, start and dc'd IV's, administered conscious sedation, GI/ENDO procedures including colonoscopy, EGD's, polypectomy, biopsy, dilatation, cleaned scopes, recovery of clients and discharge.

UTILIZATION REVIEW Precert and authorize all DME for members within company policy and Medicare guidelines. Provides frontline service to DME vendors. Precert all power wheelchairs and specialty equipment, infusions, and enteral feeding. Also help to provide inservice information to new providers and customer service as well as co-workers and case managers. Review appeal charts with medical directors when requested, review ER charts for retro payment for appeals unit and other retro/appeal charts for medical directors.

EARLY MORNING ADMISSIONS Admission assessment through patient history and physical assessment.Notify appropriate staff member, MD, or Anesthesiologist of abnormal labs or pertinent history. Administer preop medications and manage all care prior to surgery. Receive post-op patients, assess, plan discharge and manage post-op recovery. Teach patient and family discharge care.

(Formerly Phoenix HC), 3401 West

End Ave., Nashville, Tn.DME COORDINATOR Preauthorize and recert all durable medical equipment within guidelines and criteria set by company policy as well as per Medicare/Medicaid guidelines. Precert and verify member eligibility for members in the state of Tennessee. Provide frontline service to DME vendors, physicians, and members. On 24 hour call every 5 weeks. Data entry in AS400 and First Stepp and certified in Interqual training.

Mt. Juliet, Tn

R.N. INTAKE COORDINATORProvided front line service as well as back line service to providers.Verified insurance and precertification. Provided recerts and authorization for providers and case management. Reviewed and authorized managed care cases. Also coordinated patient care with affiliates for the state of Tennessee. MBI and data entry. On 24 hour call every 4 weeks. 08/31/2012 9/30/12

include supervision of CNA's, LPN's, and RN's. Coordination of shifts and assignments for flex shift personnel, current assessment of census, notification of families and physicians regarding changes in residents condition and/or emergency situations, monitoring of emergency equipment, evaluation of residents on restraint programs. Also includes coverage of units as needed, filling in as Charge nurse when needed, as well as functions of supervisory nature. Duties also include assessment of geriatric residents, individualized care planning, MDS, Quarterly Assessments, and RAPS, as well as filling out all insurance forms for residents in accordance with Medicare guidelines. Responsible for filling out PAE's (preadmission assessment) to qualify residents for Medicare.