RN-Case Manager

About the Role

Case Managers will apply systems, science, incentives, and information to improve healthcare practice and assist patients and their support systems to become engaged in a collaborative process designed to manage medical, social, and mental health conditions more effectively. The case manager's objective is to achieve an optimal level of wellness for patients and improve coordination of care while providing cost-effective, non-duplicative services.

Responsibilities

• Assess and document the clinical, psychosocial, and financial needs of patients, including availability of care support, risk for readmission, safe environment upon discharge/transition, and payor benefits. Findings are collected by interviewing patients, caregivers, and members of the interdisciplinary team. Validate and update aspects of this assessment obtained from the patient record or previous case manager assessment to influence the plan of care. (20%)
• Apply InterQual to determine/validate Level of Service and Intensity of Care. Utilize InterQual criteria within the first 24 hours of arrival to complete an initial review. Collaborate with physicians, Manager of Case Management, and physician advisors to resolve conflicts. Coordinate with bed control to attain proper placement. Perform concurrent reviews of medical records to ensure continued appropriateness and make recommendations based on patient needs. Escalate and facilitate resolution of unjustifiable aspects of care that vary from InterQual guidelines. (20%)
• With the physician, identify the plan of care, estimated length of stay, and transition/discharge plan. Meet with patients and families to engage them in the plan and obtain agreement. Incorporate all processes and procedures into the plan to ensure safe discharge/transition. Coordinate with physicians and nurses to adjust the plan as the patient's condition indicates. Use best practices and available pathways to anticipate the course of care through discharge/transition. Incorporate ancillary services as needed. Work in collaboration with social work for complex post-acute placement and community service resources. (20%)
• In coordination with nursing, ancillary departments, social work, and the physician, monitor and ensure the treatment plan and steps to prepare for transition or discharge are completed as planned, avoiding gaps in care as well as duplicative or unnecessary services. (10%)
• Ensure that patients are discharged/transitioned timely and appropriately, documenting variances from the plan or target discharge/transition date. (10%)
• Escalate concerns and barriers to appropriate treatment or transition as outlined by the department. (10%)
• Maintain a working knowledge of facilities and resources available to patients and caregivers. (10%)

Requirements

• Minimum of 3 years of experience in Healthcare/Medical-Acute Care.
• Preferred experience in Healthcare/Medical-Case Manager or Healthcare/Medical-Utilization Review.
• Graduate of an accredited School of Nursing.
• Preferred Bachelor's Degree in Nursing or Allied Health.
• Must be able to work with acutely and chronically ill patients of all ages and their caregivers.
• Excellent interpersonal communication, multitasking, prioritizing, and organizational skills.
• Demonstrated ability to work effectively with teams in a collaborative manner and escalate issues appropriately.
• Ability to work weekends and flexible hours per the department staffing plan.

Qualifications

• Licensure: Registered Nurse (RN) by the State Board of Nursing (valid for the State of MS).
• Preferred Certification by the Case Management Society of America or equivalent certification.