Department/Unit:

HBD - General Pediatrics

Work Shift:

Day (United States of America)

Salary Range:

$83,200.00 - $128,960.00

Nurse Case Manager

Under the direction of the practice physician and/or advanced practice provider (APP) and the supervision of the Nurse Supervisor (RN), the RN may provide direct patient care, patient triage (in-person and telephonic), assessment, planning, directing and evaluating of a patient’s specific care plan and clinic visit. Able to work effectively within a team of multi-specialty professionals. The Case Manager is accountable to facilitate the interdisciplinary team to plan, coordinate, implement and evaluate patient care for assigned service line across the continuum of care. The Case Manager works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve maximum clinical and financial outcomes. The Case Manager participates in maintaining quality care and performance improvement through leadership, problem solving, decision making, and outcome measurement. The Case Manager functions as a resource for the health care team, community, patient/family and payers by functioning as a clinician, consultant, advocate and educator for assigned service.

· Facilitates the utilization of resources to meet patient outcomes and contribute to Facility (AMC), New York State and National Quality data metrics

· Adheres to AMC’s regulatory agency (The Joint Commission) and internal compliance policies

· Proactively monitor patients' clinical process through /patient care standards and evidence-based guidelines to ensure timely, appropriate interventions that achieve optimal patient outcomes.

· Collaborates with the health care team and appropriate department in the management of care across the continuum of care.

· Utilizes own special body of knowledge and evidence-based guidelines to provide leadership and guidance to the health care team in formulating an individualized multidisciplinary plan of care.

· Facilitates and participates in health care team care conference for patients with complex problems. Facilitates patient and family education to promote continuity of care and optimal patient outcomes.

· Demonstrates experience in the referral process and use of community resources.

· Contacts payer source to confirm/negotiate benefits and provide concurrent reviews.

· Identifies high-risk patients based on clinical and financial criteria for collaboration with patient financial services to problem-solve available resources.

· Ensures that appropriate medical/legal documentation is contained in patient's records.

· Assesses educational needs and provides learning opportunities for health care professionals relevant to particular cases and selected patient care groups.

· Collaborates with case management leadership to compile and report aggregate variances and data for specific patient care services.

· Communicates and analyzes aggregate variances with members of the health care team and develops strategies for variance reduction.

Minimum Qualifications:

· Registered nurse with a current license.

· Bachelor's degree preferred.

· Current CPR certification required

· Minimum of three years clinical experience in an assigned service.

· Excellent customer service and communication skills

· Ability to effectively present information and respond to questions from physicians, patients and their family members or other employees within the work setting.

· Recent experience in case management, utilization management and/or discharge planning/home care in a high volume, acute care hospital preferred. PRI and Case Management certification preferred.

· Demonstrates effective communication, facilitation, and organizational skills.

· Assertive and creative in problem solving, critical thinking skills, systems planning and patient care management.

· Self-directed with the ability to adapt in a changing environment.

· Basic knowledge of computer systems with skills applicable to utilization review process.

· Experience with Epic preferred