Job Summary: Under the general supervision of the CM Director the nurse case manager manages clinical resource utilization and documentation affecting reimbursement, acting as a resource to staff and physicians in resource efficiencies and documentation that affects reimbursement. In this position the case manager provides for a planned and systematic process for monitoring and evaluation of all patients, assessing the medical, financial, psychosocial, and physical needs in planning for discharge. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication.
Essential Functions: - Reviews clinical information daily on each patient to determine if continued stay is clinically appropriate and if not, discuss the discharge plan with the physician and team.
- Partner often throughout the shift with the Discharge Planning Assistant to direct the facilitation of transition/discharge plan to arrange post-acute facility, DME, HH, etc. in a timely manner, preventing avoidable days.
- Attend daily HPIRounds with the purpose to collaborate with members of the health care team in removing barriers to discharge and managing LOS.
- Communicate current patient status, level of care and LOS in huddles and HPIRounds.
- In conjunction with Social Work interviews patients/family within 24 hours (or earlier if needed) of admission to determine if the patient needs a discharge plan and initiates the discharge plan by completing the discharge planning assessment.
- Collaborate with other care team members and patient/family to create a safe and effective transition/discharge plan.
- Responds timely to case management consults for patients.
- Refers patients to SW in a consult as indicated.
- Confers with physician for clarification/change of status order when indicated assuring the status order change has been written in the EHR.
- Collaborates with CDI in determining the GMLOS to drive length of stay.
- Initiates referral to financial counseling for patients needing assistance
- Completes Avoidable Days.
- Consults and works with medical staff, nursing, and ancillary staff regarding functional status and needs of the patient.
- Uses clear, concise, professional communication with coworkers, patients, all customers internal and external.
- Uses AIDET in interactions with patients and family members. Utilizes white boards for patient communication.
- Collaborates across disciplines to assist in coordination of patient care, including but not limited to patient transfer, discharge, referrals, and spiritual/psychosocial support needs.
- Acts with a sense of urgency when performing tasks.
- Basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
- Reports on any equipment and or environmental issues for repair.
- Abides by HIPAA (Health Insurance Portability and Accountability Act) regulations.
- Utilizes SBAR (Situation, Background, Assessment, Recommendation) when communicating with physicians and health care team.
- Speaks up to stop the line and escalates potential safety events if necessary.
- Completes and attends training as assigned.
- Other duties as assigned.
Behavioral Standards: - Treats everyone as their customer; utilizes scripting and other tools to ensure consistency in customer service; Expresses recognition and shows appreciation to others; fully utilizes AIDET principles; responds quickly to handle requests, complaints, and questions; displays a positive attitude.
- Demonstrates the highest level of professionalism, passion and care when interacting with patients, families, physicians, and hospital staff members.
- Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential, embracing ingenuity to service our customers.
Communication/Knowledge: - Wears nametag properly; follows dress code policy; answers phone correctly and promptly; is prepared for meetings; meets deadlines; does not participate in gossip; acts ethically and treats others with respect; respects customer's and co-worker's time; establishes and maintains effective relationships with customers and co-workers.
Collaboration/Teamwork: - Attends staff meetings; follows HIPAA guidelines; follows patient rights policy; complies with the compliance program; demonstrates knowledge of role in a disaster; demonstrates knowledge of fire and fire drill procedures; working knowledge of hospital emergency codes; always utilizes standard precautions in the clinical setting; safely manages the environment of care by demonstrating a working knowledge of the requirements of the: Life Safety program, Utilities Management program, Hazardous Materials program, Emergency Preparedness program, Safety Management program, Medical Equipment Management program, Security Management program.
Qualifications/Experience: - A minimum of two (2) years' experience as a RN, or two (2) years' experience as a Case Manager (RN or LVN), required.
- Consideration on a case-by-case basis for a RN without Case Management experience.
- Critical thinking, service excellence and good interpersonal communication skills, ability to read/comprehend written instructions, strong organizational skills, ability to follow verbal instructions, and PC (computer) skills.
- A capacity to learn, synthesize, make critical judgments, work independently, place patients and families first, and collaborate with the team members who are recognized leaders within health care.
