Case Manager-RN - Case Management - Day

General Summary

JOB DESCRIPTION

Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources to facilitate a patient's progression of care and the provision of appropriate, cost effective and quality health care.

Works in a team model with social work in assigned patient care areas to address patient discharge needs. Provides leadership in the integration of utilization and case management principles.

Responsibilities

• Reviews assigned patients for medical necessity, utilization management, and appropriateness of setting for continued hospitalization.
• Initiates problem-solving techniques to prevent over and/or under utilization.
• Facilitates and coordinates the progression of patient care to optimize throughput and the utilization of resources to support continuous quality and cost of care efforts.
• Liaisons between utilization management team, third party payers, and the treatment team regarding the identified treatment plan in accordance with contractual guidelines and System policy.
• Affords assistance to the patient care team with the identification and coordination of alternative treatment settings to provide appropriate care, maintain quality of care, and reduce cost.
• Identifies conditions which require case management across the care continuum.
• Collaborates with members of the patient care team to identify interdisciplinary needs.
• Collaborates with care management across the system to effectively transition patient care and support value-based care initiatives.
• Completes case management patient assessment, identifies needs, develops a discharge plan, and coordinates discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families, and care team.
• Affords assistance with the collection and analysis of utilization patterns, length of stay, readmissions, avoidable days, and denied cases.
• Brought to attention of the appropriate manager(s) any known or suspected problems of under-, over-, or inappropriate utilization of resources.
• Demonstrates a commitment to patient, visitor, and staff by complying with all applicable safety regulations, learning the impact of medical errors and methodology that will lead to reduction of errors; reporting actual and potential errors, as well as hazardous conditions; identifying opportunities to standardize processes and “error proof” systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required.
• Prepares and maintains appropriate documentation as required.
• Maintains established policies and procedures, objectives, quality assessment and safety standards.
• Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
• Prepares and presents utilization data analysis as required.
• Participates in the development and delivery of educational information and process improvements related to job accountabilities and case management principles.
• Attends meetings as required.
• Performs other related duties as identified.

Qualifications

• Minimum Education: Associates Degree Required. Bachelors Degree Preferred.
• Work Experience: 2 years Recent acute care experience Required.
• Field of Experience: In Utilization Management, Case Management, or Clinical Nursing Specialty. Preferred.
• Licenses: Licensed Registered Nurse Upon Hire Required. Multi State License Upon Hire Required. Basic Life Support Upon Hire Required. Certified in Case Management Preferred.
• Knowledge, Skills, and Abilities: Excellent interpersonal and communication skills. Basic computer skills. Desire and ability to work in a supportive and collaborative team environment.