Care Manager II - Case Management

Works in collaboration with the patient/family, physicians, and multidisciplinary team members to ensure patient progression through the continuum of care and to develop a plan of care for each assigned patient from admission through discharge. The Care Manager is responsible for identifying, initiating, and managing optimal patient flow/throughput to enhance continuity of care, smooth and safe transitions, patient satisfaction, patient safety, and length of stay management.

Responsibilities

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Coordinates the integration of case management functions into the patient care and discharge planning processes in collaboration with other hospital departments, external service organizations, agencies, and healthcare facilities.
• Coordinates/facilitates patient care progression throughout the continuum of care in an efficient and cost-effective manner.
• Serves as resource, provides support, and advocates on behalf of the patient related to treatment decisions and end-of-life issues.
• Closely monitors patient length of stay in regard to the geometric mean length of stay and communicates/collaborates with appropriate interdisciplinary team members to remove barriers and expedite discharge.
• Implements and monitors the patient’s plan of care to ensure effectiveness and appropriateness of services.
• Identifies and escalates local and system barriers that are impeding diagnostic or treatment progress and issues related to quality and risk as appropriate in a timely manner.
• Proactively identifies and resolves delays and obstacles to discharge.
• Uses advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
• Interviews patients/families to obtain information about social, emotional, and financial factors which impact health status to develop comprehensive discharge planning assessment and care plan.
• Assesses needs for discharge planning and continuing care/resource support following discharge; independently makes recommendations to patients and families regarding post-acute level of care needs and options including:
  • Acute Rehabilitation Placement
  • Nursing Home or Skilled Nursing placement
  • Psychiatric or Substance Abuse placement
  • New Dialysis
  • Child/Adult/Domestic Abuse
  • Home Health/Hospice Referrals
  • Legal issues (adoptions, guardianship)
  • Assistance with Advance Directives
  • Community Resource needs
  • Financial Issues/Funding options
  • DME Referrals and Coordination
  • Social Determinants of Health
• Initiates discharge planning at the time of admission and makes post-hospital service referrals based upon information gathered during assessment and interactions with physicians, multidisciplinary care team, and payors as indicated.
• Acts as patient advocate by negotiating for, and coordinating, resources with payors, agencies, and vendors.
• 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.
• Provides appropriate interventions which demonstrate knowledge of and sensitivity toward cultural diversity and the religious, developmental, health literacy, and educational backgrounds of the patient population.
• Assesses the patient’s formal and informal support system as well as available benefits and/or community resources.
• Meets directly with patient/family to assess needs and develop an individualized care plan in collaboration with the physician.
• Ensures and maintains plan consensus from patient/family, physician, and payor.
• Provides education, information, direction, and support related to patient’s goals of care.
• Acts as patient advocate to develop treatment plan and coordinate patient care and to transition patient to the appropriate next level of care.
• Demonstrates and promotes respect for the dignity and rights of every patient while adhering to the safety standards and practices of the organization and the nursing profession.
• Collaborates with the physician and other health care professionals to promote appropriate use of medical center resources.
• Provides information and support to patients and families, helping them access needed resources within the medical center and community.
• Actively participates in clinical performance improvement activities involving length of stay, resource utilization, avoidable days, cost per case, and readmissions.
• Measures effectiveness of interventions through direct communication with post-acute care providers, patients, and caregivers.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
• Actively participates in Multidisciplinary/Patient Care Progression Rounds.
• Escalates cases as appropriate and per policy to Physician Advisors and/or CM Director.
• Documents in the medical record per regulatory and department guidelines.
• May be asked to assist with special projects.
• May serve as a preceptor or orienter to new associates.
• Assumes responsibility for professional growth and development.

Requirements

• Excellent verbal and written communication and ability to interact with diverse populations.
• Critical and analytical thinking skills.
• Demonstrated clinical competency.
• Ability to multitask and function in a stressful and fast-paced environment.
• Working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
• Understanding of pre-acute and post-acute levels of care and community resources.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and their families.
• Understanding of internal and external resources and knowledge of available community resources.
• Ability to move around the hospital to all areas for the majority of the workday while in the office the rest of the day; general office and hospital environment.

Qualifications

• Graduate of an accredited school of nursing (BSN preferred) or Master’s Degree in Social Work (MSW) required, or demonstrated success in CHRISTUS Care Manager I Position for at least 5 years on top of the required experience in lieu of education.
• Two or more years of clinical experience with one year in the acute care setting preferred.
• RN or LMSW in the state of employment is required for new hires. LBSW accepted for associates with 5+ years of demonstrated success and experience in CHRISTUS Care Manager I role.
• Certification in Case Management preferred.
• BLS preferred.

Schedule

Multiple shifts available.

Work Type

Part Time