Case Manager NEX

Qualifications

• Graduate from an accredited school of nursing
• BSN required; MSN preferred
• Minimum 5 years of relevant clinical experience
• Previous Case Management experience preferred
• Current licensure to practice as a Registered Nurse in the applicable state
• Certification in case management highly recommended within 2 years of employment

Responsibilities

• Identifies patients who would benefit from Case Management interventions based on an initial screening assessment of discharge needs
• Assesses all relevant data and obtains information by interviewing patient/family and performing objective evaluation of patient needs
• Ensures that a Plan of Care is developed and implemented in conjunction with nursing to enhance client outcomes in a cost-efficient manner by defining desired patient outcomes (goals) with other members of the team
• Collaborates with the patient, caregivers, the multidisciplinary team, and community service providers to effectively execute the Plan of Care
• Coordinates the discharge planning process; ensuring discharge planning needs are completed
• Evaluates and monitors the effectiveness of the discharge planning by facilitating changes in Plan of Care as needed with all members of the multi-disciplinary team
• Documents Case Management actions in the Electronic Medical Record and communicates necessary information to providers and payors
• Participates in multi-disciplinary rounds to communicate discharge planning and drive patient progression through the system
• Establishes partnerships with physicians to achieve institutional goals and contribute to excellent patient care by the organization
• Identifies system issues and suggests interventions to the Supervisor to eliminate duplication in services and documents significant variances
• Identifies trends/process barriers and participates in development of plans to ensure effective patient movement through the care continuum
• Monitors medical necessity of admissions, continued hospitalization, and surgical procedures using criteria approved by the medical staff and evaluates appropriate level of care for patient; notifies Utilization Review staff of necessary changes
• Utilizes principles of quality improvement in every aspect of performance by participating in unit and organizational quality improvement activities to develop strategies to reduce or resolve variations in practice
• Provides age/developmentally-appropriate patient planning and communication in accordance with Age-Specific Care Guidelines for the specific age groups served
• Maintains working knowledge of payer and reimbursement practices impacting the plan of care
• Demonstrates the ability to guide the patient and family through an evaluation of their options for post-discharge care

Skills

• Good interpersonal, communication (verbal, nonverbal, and listening), and written communication skills
• Case Management experience
• Basic computer skills
• Ability to work in a continually changing work environment

Work Environment

• May be exposed to infectious and contagious diseases
• May be exposed to radiation hazards
• Contact with patients under a wide variety of circumstances
• Subject to many interruptions
• Subject to irregular hours

Physical Requirements

• Standing: 0% to 35%
• Walking: 35% to 65%
• Sitting: 65% to 100%
• Bending: N/A
• Reaching with arms: N/A
• Finger and hand dexterity: Required
• Talking: Required
• Hearing: Required
• Seeing: Required
• Lifting, carrying, pushing, and/or pulling up to 20 lbs.: Required
• Lifting, carrying, pushing, and/or pulling up to 50 lbs.: Occasionally
• Lifting, carrying, pushing, and/or pulling up to 100 lbs.: N/A