Case Manager, RN
Case Manager, RN
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
The three main goals of case management are quality care access to healthcare services and cost efficiency. The case manager is responsible for case finding and intake provision of case management services outcomes evaluation and case closure daily utilization management activities and psychosocial and economic issues management of our patients.A critical attribute required of this position is exceptional interpersonal customer service consisting of an outgoing positive attitude warm friendly joyful demeanor and the utmost care and reverence for our guests patients families customers and colleagues.
Education & Qualifications:
- Graduate from an accredited school of nursing (RN) required bachelors preferred.
- Knowledge and skills necessary to provide care appropriate to the population served in the CM Department.
- Two (2) or more years clinical experience preferred.
- Acute care or community social agency case management experience preferred.
- Utilization Review experience preferred.
- Must possess good assessment intervention and problem-solving skills.
- Must be able to address the physical cognitive emotional financial and psychosocial capabilities of the patient/family.
- Able to develop and maintain collaborative and professional relationships with multiple stakeholders (patient/family nursing staff physicians payers and external agencies). Ability to understand medical terminology and principles.
- Ability to communicate effectively and efficiently verbally and in writing. Basic computer skills (Outlook Word Excel and databases) are a must.
- Ability to meet required deadlines while maintaining expected quality.
- Good organizational skills with the ability to establish priorities and switch focus with frequent interruptions.
- Required Certification: Case Management Certification (CCM) preferred.
- Required License: Current state RN license or Multistate licensure with the authority to work in WA
- Other: Bilingual and/or English-Spanish speaking abilities preferred. Ability to work with culturally diverse populations.
Responsibilities
- Case Management: work in conjunction with the medical team in developing best discharge plan available and understanding patient/family needs and wants with safe appropriate collaboration between all parties
- Educate patients families and others on all aspects of discharge planning
- Responsible for the coordination and implementation of case management strategies pursuant to the Case Management Plan
- Utilization Review: review charts for appropriate levels of care and or continued stay
- Works with physicians and insurance companies to best manage patients and their stays
- Utilization Review Management Processes
- Review clinical information for concurrent reviews extending the Length of Stay for inpatients as appropriate
- Responsible for authorization of appropriate services for continued stay and through discharge
- Report to work on time and as scheduled complete work within designated timelines
- Demonstrates the ability to adhere to the mission ethics and goals of Lourdes/Trios Health
- Establish effective rapport with other employees professional support service staff customers patients families and physicians
- Use effective relationship management coordination of services resource management education patient advocacy and related interventions to:
- Promote improved quality of care and/or life
- Promote cost effective medical outcomes
- Prevent hospitalization & re-hospitalization when possible and appropriate
- Promote decreased lengths of hospital stays when appropriate
- Prevent complications in patients under our care when possible
- Provide for continuity of care
- Assure appropriate levels of care are received by patients
- Identifies barriers/variances to discharge for any patient who will unlikely meet anticipated discharge
- Prioritize case reviews daily based on: Time limits for outpatients in on the unit medical necessity determination for continuing stay for patients and Insurance reviews required
- When patient situations reviewed suggest potential LOS or quality of care issues involving physicians or care team omissions commissions or lack of action (when variances are identified) works with Care Coordination Services leadership for determination of need for further review and referral
- On a prioritized case basis conducts an assessment of the case situation to identify complex issues or dynamics involving care treatment or discharge
- Recommend with nursing leadership that a case conference be held to problem-solve complex issues related to care treatment discharge or decision-making
- May coordinate participate in and/or assist leading care conferences
- Work in coordination with the entire medical team to move cases towards a safe discharge
- Determines need for and recommends changes in level of care and location of care based on defined standards and judgment
- Consults as necessary with physician (s) patient/family nursing staff third party reviewers and other disciplines regarding realistic clinical outcomes balanced with financial considerations
- Reviews nursing assessment as to patients home needs self-care safety nutrition financial status transportation family-community support etc.
- Document findings and recommendations as to needs expressed by the patient and/or family or needs that were addressed and discharge plan to suffice those needs if within our scope or to whom referred and contact information
- Review discharge instructions with patient to include but not limited to; follow-up appointment medications ready at pharmacy at time of discharge.
- Confers with leadership as needed about resource options for patients and families
- Cross train to and perform other UR processes as time and needs require
- Determines with Risk Management staff and/or Medical Staff Offices Manager when cases may require review by Risk Management Medical Staff Services or other related leadership staff due to concerns about safety practice and resource use decision-making
- Provides case assessment and referrals to community resources and hospital resources out of the ED
Required Experience:
Manager
Employment Type
Full-Time
