Case Manager , RN (FH) (Per-Diem Weekends)

About the role

Facilitates patient's hospitalization from pre-admission through post-discharge. Coordinates with physicians, nurses, social workers and other health team members to expedite medically appropriate, cost-effective care. Assesses, plans, oversees and evaluates the appropriateness of care across the acute care continuum. Applies clinical expertise and medical appropriateness criteria to resource utilization and discharge planning.

Responsibilities

• Coordinates and facilitates patient care throughout hospitalization
• Performs a case management intake assessment
• Orients patient to the role of the case manager, the goals of care and expected length of stay
• Discusses with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan
• Participates in interdisciplinary patient care rounds
• Discusses estimated length of stay, treatment and discharge plan with the attending physician, as indicated
• Identifies and assists in removing barriers to patient care (variances) and resolves issues with appropriate departments and staff
• Coordinates and facilitates transitional planning needs through the acute care continuum
• Makes referrals to social work as identified through the high risk screening process using high-risk criteria
• Consults with the physician regarding physical therapy, nutrition, speech therapy, respiratory therapy and other ancillary services as needed
• Collaborates with members of the interdisciplinary team to assess, plan, implement, coordinate and monitor services required to achieve quality patient care and resource management
• Serves as liaison between patients, families, physicians, payers and other members of the interdisciplinary care team
• Coordinates and facilitates the discharge planning process
• Initiates discharge planning by assessing the patient's needs and documenting the assessment on the interdisciplinary care team
• Works collaboratively with the physician and interdisciplinary team to determine the patient's need for continuing care services
• Ensures interdisciplinary care plan and discharge plan are consistent with the patient's clinical course, continuing care needs and covered services
• Conducts a case management assessment including the patient's physical, psychosocial and financial needs and issues
• Interviews patient or designated agent to assess discharge-planning needs
• Involves patient and/or family in discussion and planning for anticipated need for care following discharge
• Ensures discharge plan is safe and timely
• Completes paperwork and/or ensures paperwork is completed and distributed
• Ensures patient and/or family are given information regarding their choices regarding transfer to another level of care according to regulatory standards
• Ensures continuing care services including transportation, durable medical equipment, etc are appropriately arranged for and financially approved
• Performs concurrent utilization management
• Reviews appropriateness of patient's admission, need for continued stay and discharge criteria using established criteria
• Discusses with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan
• Ensures patient meets acute care criteria during each in-patient day
• Places patient on alternate level of care (ALC) status in concert with attending physician
• Responds to third party payer requests for concurrent clinical information providing all relevant documentation to ensure reimbursement within expected time frames
• Disseminates documents of non-coverage when appropriate
• Ensures compliance with current state, federal and third party payer regulations
• Works collaboratively with on-site reviewers to transition patients to appropriate discharge settings
• Participates in quality management of patient care outcomes
• Identifies and collects quality data including pre-established quality screens, NYPORTS and core measures
• Identifies and reports quality issues to the department management
• Ensures minimum quality standards are met each day of hospitalization
• Documents case management process in the medical record
• Documents on-going process of discharge planning including discharge assessment, plan and on-going evaluation and updates
• Provides summary note at time of discharge synthesizing the discharge plan and follow-up care needs
• Completes appropriate portions of Patient Discharge Instruction Sheet
• Completes and facilitates completion of the Patient Review Instruments (PRI) with other disciplines
• Completes case management intake assessment form
• Completes relevant documents including Patient Transfer Form
• Documents on-going case management progress notes in the medical record
• Performs related duties, as required

Qualifications

• Bachelors Degree in Nursing, required
• Masters Degree, preferred
• Current license to practice as a Registered Professional Nurse in New York State
• Patient Review Instruments (PRI) Certification, preferred
• Certification in Case Management, preferred
• Minimum five (5) years clinical experience as a registered nurse
• Prior experience in utilization management and/or discharge planning, preferred
• A strong clinical background and an understanding of the preparation and post procedure monitoring requirements for diagnostic/radiological and/or surgical procedures
• PC literate. Knowledge of Microsoft Office, Excel, spreadsheet management required