Case Manager - RN Full Time Day Shift

Job Summary

Under the general supervision of the CM Director, the nurse case manager manages clinical resource utilization and documentation affecting reimbursement, providing a planned and systematic process for monitoring and evaluating all patients.

About the Role

Actively and consistently contributes to department operations and communications, behaving in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication.

Essential Functions

• Reviews clinical information daily on each patient to determine if continued stay is clinically appropriate and discusses the discharge plan with the physician and team.
• Partners with the Discharge Planning Assistant throughout the shift to facilitate the transition/discharge plan, arranging post-acute facilities, durable medical equipment (DME), home health (HH), etc., in a timely manner to prevent avoidable days.
• Attends daily HPIRounds to collaborate with the health care team in removing barriers to discharge and managing Length of Stay (LOS).
• Communicates current patient status, level of care, and LOS in huddles and HPIRounds.
• Conducts interviews with patients/families within 24 hours of admission to determine if a discharge plan is needed and initiates the discharge plan by completing the discharge planning assessment.
• Collaborates with other care team members and patient/family to create a safe and effective transition/discharge plan.
• Responds timely to case management consults for patients, referring them to Social Work as needed, and collaborates with physicians for clarification/change of status orders.
• Collaborates with Clinical Documentation Improvement (CDI) to determine the General Medical Length of Stay (GMLOS) to drive length of stay.
• Initiates referrals to financial counseling for patients needing assistance.
• Completes Avoidable Days.
• Consults and works with medical staff, nursing, and ancillary staff regarding the functional status and needs of the patient.
• Utilizes clear, concise, professional communication with coworkers, patients, all customers internal and external, and uses AIDET in interactions with patients and family members.
• Utilizes white boards for patient communication and collaborates across disciplines to assist in coordination of patient care, including patient transfer, discharge, referrals, and spiritual/psychosocial support needs.
• Acts with a sense of urgency when performing tasks.
• Performs basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
• Reports on any equipment and/or environmental issues for repair.
• Absolves HIPAA (Health Insurance Portability and Accountability Act) regulations.
• Utilizes SBAR (Situation, Background, Assessment, Recommendation) when communicating with physicians and healthcare team.
• Speaks up to stop the line and escalates potential safety events if necessary.
• Completes and attends training as assigned.

Qualifications/Experience

• A minimum of two (2) years’ experience as a Registered Nurse (RN), or two (2) years’ experience as a Case Manager (RN or LVN), required.
• Consideration on a case-by-case basis for a Registered Nurse (RN) without Case Management experience.
• Critical thinking, service excellence, and good interpersonal communication skills.
• Ability to read and comprehend written instructions, strong organizational skills, ability to follow verbal instructions, and PC (computer) skills.
• A capacity to learn, synthesize, make critical judgments, work independently, place patients and families first, and collaborate with the team members who are recognized leaders within health care.