NMHS
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We believe a career is more than just a career — it's a calling. Our teammates' "True North" is what calls them to health care; it’s their passion. At North Mississippi Health Services, we believe in helping you leverage and connect that passion with a much greater purpose that impacts people you know and love.
41007910 Case Management
The MDS Coordinator at North Mississippi Health Services System is pivotal in coordinating patient care and resource utilization. The coordinator monitors individual cases to ensure compliance with established criteria and patient care guidelines, collaborates with the healthcare team for effective patient care planning, and plays a critical role in discharge planning.JOB FUNCTIONS Review Activities: Monitors individual cases in relation to established criteria, LOS & patient care guidelines. Assures patient is meeting level of care criteria & issues denial of care letters as necessary. Intervenes as indicated to promote the timely provision of care & utilization of resources. Serves as a resource for physicians & nurses in understanding criteria for continued stay & medical necessity. Monitors patient outcomes to evaluate clinical & financial effectiveness. Reconciles services rendered with patient benefits & communicates with physicians & 3rd party payers to assure appropriate reimbursement. Manages/supervises social work and case management as a team to facilitate discharge planning needs of the patients. Clinical Practice: Collaborates with patient care team to move population along the continuum by effectively planning for continued care as moving to another level of care to ensure all patient needs are addressed. Assesses social/emotional factors affecting health status of patients & makes appropriate referrals. Participates on Discharge Planning Team & initiates d/c planning early in the treatment process based on requirements of the plan of care & needs identified during initial assessment. Complies with regulatory and accrediting agency requirements and ascertains that other staff is complying as well through staff development endeavors. Swing Bed Responsibilities: Participate on SWB Team and facilitates screening of patients for eligibility. Provides SWB information to patients & families as appropriate. Monitors patient progress for timely discharge to the appropriate setting. Responsible for MDS as required for billing/reimbursement. Reports: Identifies & reports physicians practice patterns & resource utilization. Maintains accurate records of review & discharge planning activities. Customer Service: Maintains constructive working relationships & communication with physicians, professional staff, and other members of the health care team regarding issues of continued stay & documentation of medical necessity. Collaborates with business office to ensure accurate billing and statistical information. Collaborates with social worker to identify & coordinate resources, internal and external, to best meet patient needs. Competent to communicate on all levels to assess discharge needs of all age groups of patients. Participates in educational meetings with physicians office personnel as requested. Knowledge Skills and Abilities Ability to read & interpret medical record documentation Ability to operate a PC Good organizational skills & high level of self-initiative Effective verbal & written communication skills Extensive knowledge of various regulatory and accrediting standards. Knowledge of Minimum Data Set (MDS) and care plans in order to facilitate the processing of necessary information to the required agencies. Demonstrate the ability to work effectively with physicians and other nurses to initiate & pace accomplishment of responsibilities with minimal supervision & resolve complex problems related to patient outcomes & activities Participates in departmental performance improvement efforts Initiates interaction with physicians & other members of the health care team as indicated to resolve problems/issues related to UR/SWB activities Primary responsibility for coordinating the activities of the MDS and must have good assessment, planning, implementing and evaluating skills. Accountable for collaborating with physicians, professional staff, various ancillary departments, and community resources to plan & implement appropriate patient care across a continuum, for the implementation of utilization review, precertification, discharge planning, & documentation monitoring Assists business office with special needs to affect accurate and timely billing Physical Demands
A thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
$71,864.00 - $107,785.60
Associate’s Degree | Nursing | Required
Registered Nurse (MS) - MS Board of Nursing