Nexus Health Systems Jobs (2)

The Case Manager is responsible for directing and coordinating the functions and activities of health care services delivery and discharge planning with the multidisciplinary team.

The Case Manager facilitates communication and coordination between the health care team members involving both the resident and family in the decision-making process.

Activities include encouraging appropriate use of health care services and striving to improve quality of care and maintain cost-effectiveness on a case-by-case basis.

The Case Manager is responsible for establishing a positive relationship with payer sources and initiating necessary documentation for re-authorization of the resident's continued stay.

JOB SPECIFIC RESPONSIBILITIES :

• Assembles treatment team to conduct admissions conference with patient and / or support persons.
• Assures a secure and comforting welcome to patient / support person upon admission.
• Upon patient admission, contact external payor source case manager / representative of the patient's actual admission and reviews schedule for clinical updates.
• Completes admission forms as required on each assigned patient.
• Uses admission profile information to prepare for discharge planning and updates profile as patient / family context changes.
• Liaisons with patient's attending physicians and medical staff to ensure patient's medical needs are met.
• Liaisons with treatment team members to ensure patient's treatment is accurately focused on patient needs.
• Coordinates with medical staff to attend weekly team rounds and arrange for diagnostics, equipment, supplies, or medicals services as ordered.
• Completes Clinical Pre-assessments on patients as needed.
• Provides input to the Administrator regarding Case Management issues.
• Provides third-party payor sources with appropriate clinical updates as per the agreed-upon reporting schedule.
• Presents a positive and helpful working relationship with all external case managers / representatives and community agencies, demonstrating effective internal case management.
• Acquires appropriate information to address payor denials necessary to receive payment due.
• Maintain initial and ongoing documentation in the medical record regarding patient status related to treatment progress, family issues, estimated length of stay, and discharge needs.
• Arranges proper and timely discharge planning for all patients in coordination with family or support persons.
• Coordinates input and feedback from a multidisciplinary team, patient's family, or support persons for discharge needs from admission to actual discharge.
• Acquires necessary community resources to meet the patient's needs before discharge.
• Coordinates discharge with patient's payer sources and community services to ensure a safe, timely, and effective discharge is achieved.
• Verifies community services have been arranged to ensure a timely and uninterrupted discharge transition of a patient is to the most appropriate setting.
• Resolves patient family or support person's complaints or concerns to appropriate team members and follows up to ensure resolutions are acceptable to all parties.
• Exhibits a positive professional demeanor to residents and relevant parties, offering constructive communication, cooperation, and assistance to ensure a satisfactory patient stay of treatment.
• Provides effective assistance and positive relations with co-workers that demonstrate collaborative multidisciplinary treatment team approach to resident or program problem-solving issues.
• Provides timely information / feedback to the designated supervisor on any resident / family / support person / payor source relevant issue that could jeopardize the patient's treatment, family / support person / payor sources, or discharge planning issue.
• Communicates with the manager and department directors to ensure team-focused patient-centered care.
• Performs other duties as assigned.

POSITION QUALIFICATIONS :

EDUCATION :

Bachelor's Degree in health care field preferred

EXPERIENCE :

• Experience in pediatric case management
• Strong background in healthcare
• 3-5 years direct pediatric patient care experience

LICENSURE / CERTIFICATION :

• Current license as a Registered Nurse or Social Worker in the state of Texas.
• Current AHA BLS certification.

POSITION SUMMARY :

A coder for Nexus Health Systems has the primary role of accurate coding and DRG assignment for all Nexus facilities. Under the System Director Health Information Management supervision, the coder will maintain professional certification while demonstrating a working knowledge of LTC MS-DRGs, APR-DRGs, ICD-9-CM, ICD-10-CM, and CPT coding requirements.

The coder will be directly responsible for admission, concurrent and discharge coding, meeting the facility coding turnaround times, abstracting, coding query compliance, working with CDI to improve physician documentation and metrics utilization.

This 100% remote corporate position is based out of Nexus Specialty Hospital. The position requires travel to the facility only for scheduled meetings and mandatory in-services.

JOB-SPECIFIC RESPONSIBILITIES :

Adheres to the turnaround times designated by Nexus for timely and accurately coding, timely communication of DRG assignment and updates, and claim creation for timely billing.

The coder is responsible for assigning principal diagnosis within 24 hours of H&P completion, daily concurrent abstracting and review, and final DRG and code assignment within 72 hours of discharge.

Accurately abstracts and audits medical records for documentation compliance and accuracy to reflect accurate code assignment to support illness severity and service intensity.

Recognizes the role of a coder and how it relates to the overall clinical function of the hospital regarding correct documentation of patient care and fiscal reimbursement.

Identifies documentation improvement areas through admission, concurrent, and discharge abstracting and utilizes coding queries to meet specific coding guidelines.

Creation, implementation, and tracking of coding query compliance for physicians.

Plays an active role in the weekly DRG multi-disciplinary meetings to educate and gain clinical knowledge that can be utilized to optimize DRG assignment and documentation.

Accurately updates HIM Statistics related to admission, discharges, code assignment, final CMI, and LOS data. Keeps track of LOAs and updates DRG spreadsheet daily.

Consistently demonstrates the ability to promptly recognize, establish, and deal with issues. Strives to meet daily deadlines and demonstrates good time management skills, and participates in special projects and studies as assigned.

Maintain a 90% accuracy rate on coding audits performed monthly. Five percent of discharges will be audited monthly.

Assistance with RAC and third-party audit reviews related to coding and documentation issues.

Identifies and works towards resolutions of problems with charts or physicians that can cause delays with coding and / or clinical care.

Takes initiative to self-educate on the latest federal, state, and accreditation guidelines related to HIM and coding. Actively uses coding clinic and latest coding guidelines and conventions for accurate code assignment.

Utilizes and completes all 3M education coding modules for ICD-10

Works closely with the facility to ensure administration, case management, and the liaisons are aware of all coding changes and documentation barriers.

Attends coding round tables, meetings, and in-services and assigned.

Performs other duties as assigned.

POSITION QUALIFICATIONS :

EDUCATION :

Completion of a 2 or 4 year accredited Health Information Management degree program preferred.

EXPERIENCE :

• Minimum of 4 years experience with inpatient ICD-9-CM and PCS coding and CPT coding. Long Term Acute Care coding experience preferred.
• Working knowledge of LTC-MS-DRGs, APR-DRG’s, coding query utilization, and documentation improvement practices.
• ICD-10 Training completed. Dual coding experience preferred.

LICENSURE / CERTIFICATION :

RHIA, RHIT, or CCS with certification maintenance

Maintain current certification in good standing during employment with this facility, or obtain within thirty (30) days of hire