Case Manager - RN - Care Coordination
5 - 7 years experience • Healthcare IT
Case Manager - Care Coordination. Full-time, weekends - every Friday, Saturday, Sunday with working hours 0800-1830.
Job Summary: The Case Manager is a leadership position that coordinates, facilitates, and/or manages patient care, using clinical nursing skills and knowledge of resource management and clinical care requirements for a designated population(s). Promotes the achievement of optimal clinical and resource outcomes and is responsible for facilitating appropriate lengths of stay and reimbursement for all hospital admissions in accordance with its goals and objectives. Acts as the key information and education resource for the interdisciplinary team. Works to develop organization-wide approaches to problem solving. Analyzes current systems and variances to identify opportunities for improvement. Works to promote quality of care through collaboration with all team members, patients and families. Plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Facilitates the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
Education / Experience: Graduate from an accredited school of nursing. BSN required. ADN/Diploma in Nursing with a minimum of 5 years' experience in utilization management in lieu of BSN acceptable. MSN preferred. Minimum 5 years of relevant clinical experiencerequired. Previous Case Management experiencepreferred.
Licensure, Certification and / or Registration: Current licensure to practice as a Registered Nurse in the State of North Carolina. Certification in case management highly recommended.
Essential Functions (All Campuses):
1. Oversees the management of specific patient populations across the continuum. Serves as a resource to the multidisciplinary team for the management of complex patients.
2. Works with physician leadership and the multidisciplinary team for defined patient populations to develop clinical pathways, continuum care management programs, measurement and feedback of performance indicators for cost, quality, and service.
3. Facilitates learning experiences of healthcare team members, conducts in-services, and/or serves as a resource for pathway development.
4. Coordinates/facilitates patient care progression throughout the continuum.
Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge.
Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
Utilizes conflict resolution skills as necessary to ensure timely resolution of issues.
Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis:
Completion and reporting diagnostic testing;
Completion of treatment plan and discharge plan;
Modification of plan of care, as necessary, to meet the ongoing needs of the patient;
Communication to third party payers and other relevant information to the care team;
Assignment of appropriate levels of care;
Completion of all required documentation in electronic medical record and in Maxsys.
5. Collaborates with medical staff, nursing staff, social workers, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
6. Completes Utilization Management for assigned patients.
Applies approved medical necessity criteria to monitor appropriateness of admissions and continued stay, and documents findings according to department standards.
Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
Refers cases and issues to Medical Director and/or EHR physician advisors in compliance with department procedures and follows up as indicated.
7. Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
8. Manages all aspects of discharge planning for assigned patients.
Screens all patients on assigned unit(s) to identify patient/family needs.
Assures development of an individualized continuing care plan in collaboration with other team members.
Collaborates and communicates with multidisciplinary team in all phases of discharge planning process.
Ensures/maintains plan consensus from patient/family, physician and payer.
Refers appropriate cases for social work intervention based on department criteria.
Collaborates/communicates with external case managers and/or external providers.
Initiates and facilitates referrals for home health care, hospice, medical equipment, transportation, supplies and community resources to meet individual patient needs
Documents relevant discharge planning information in the medical record according to department standards.
Facilitates safe and appropriate transfer to other facilities as appropriate.
9. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
Skills and Qualifications:
Effective verbal and written communication skills.
Excellent interpersonal and negotiation skills
Demonstrated leadership skills
Strong analytical, data management and computer skills
Proficient with Microsoft Office Word, Excel and Outlook
Works in a continually changing work environment
Effective problem-solving and decision-making skills
Effective assessment and teaching skills
Motivation for self-direction
Strong organizational and time management skills.
Ability to work independently and exercise sound judgment in interactions with physicians, payers and patients and their families.
Ability to work collaboratively with patients, families, multidisciplinary team and community agencies to achieve desired patient outcomes
Competence related to age and developmentally appropriate care.
Ability to analyze, develop and manage change
Demonstrates knowledge of healthcare regulation and funding as it impacts to delivery of patient care.
Demonstrates knowledge of state, federal and commercial payer requirements and guidelines effecting hospital level of care eligibility, applying nationally recognized criteria to determining qualifications for hospital level of care.
Demonstrates knowledge of NC mental health system of services
May be exposed to infectious and contagious diseases.
Contact with patients under wide variety of circumstances.
Subject to many interruptions.
Subject to irregular hours.
Moderate noise environment.
High stress levels at times.
Continually changing work environment
Amount of time spent performing the following activities:
0% 35% 65%
to to to
35% 65% 100% N/A Activity
X Reaching with arms
X Finger and hand dexterity
Lifting, carrying, pushing and or pulling:
X 20 lbs. maximum
X 50 lbs. maximum
X 100 lbs. maximum
Job ID: 22794