Job Description
To maintain high-quality, medically necessary, evidence-based care, and efficient treatment of all patients, regardless of payment source, by ensuring the patients receive the right care, at the right time, in the right place.
Case Management Model: utilize an Integrated Case Management Model. Under this model the Case Managers will follow patients through the continuum while facilitating the functions of, care coordination, advocacy and discharge planning.
Responsibilities
Clinical review of 100% acute bedded patients including patients admitted to Inpatient and Observation level of care at The Christ Hospital.
Monitors patients for appropriateness of continued stay, level of care and services, and quality of care using approved screening criteria.
Responsibilities specific to discharge planning including assessment, identification of specific needs, and social service intervention or referral while in the acute setting.
Awareness of services available to patients and their families upon assessment.
Determining patient needs on basis of diagnosis; prognosis and social support system/person information are included in the initial assessment process. Upon individual recognition and staff referral, the RN Case Manager will contact the appropriate agency to meet the patient’s social, emotional and spiritual needs.
Identify/facilitate patient status from observation to inpatient as patient clinical condition warrants and communicating the information to the utilization review nurse.
Communicate with physicians when alternatives to inpatient care are indicated by clinical review.
Develop a discharge plan based on screening and assessment tools utilized by the Case Manager. Education of the discharge plan including health care recommendations to the patient, family, caregiver, and other hospital personnel
Proactively identify potential barriers to discharge, for example: alternative levels of care, financial coverage issues, psycho/social behaviors, and self-care challenges.
Work with external agencies and ancillary providers by completing discharge plans for services provided at an alternate level of care.
Facilitates daily huddles and multidisciplinary team rounds to include IS/SI, discharge plan, length of stay, barriers to discharge, and delays.
Participate in hospital based committees as requested by management.
Identifies potential delays in service or treatment and refers to the appropriate individuals within the multidisciplinary patient care teams for action/resolution.
Track and trends avoidable day information in Midas per policy.
Interfaces with patient registration, financial councilors, Social Work, and patient financial services etc. to collaborate on financial issues.
Document pertinent barriers to discharge and acceptable discharge plan weekly for admissions with high financial impact to the organization and admissions with an increased length of stay.
Identifies potential delays in service or treatment and refers to the appropriate individuals within the multidisciplinary patient care teams for action/resolution.
Track and trends avoidable day information in Midas per policy.
Interfaces with patient registration, financial councilors, Social Work, and patient financial services etc. to collaborate on financial issues.
Document pertinent barriers to discharge and acceptable discharge plan weekly for admissions with high financial impact to the organization and admissions with an increased length of stay.
Performs other duties as assigned, including but not limited to:
- Demonstrates professional responsibility in the role of an RN-Case Manager
- Complies with department and hospital policies at all times
- Maintains compliance with State/Federal Guidelines and standards
- Conforms to all requirements of Medicare
- Keep current on changing laws and requirements of Medicare/Medicaid
- Demonstrate a positive attitude at all times
Qualifications
KNOWLEDGE AND SKILLS:
Please describe any specialized knowledge or skills, which are REQUIRED to perform the position duties. Do not personalize the job description, credentials, or knowledge and skills based on the current associate. List any special education required for this position.
EDUCATION: Bachelor’s Degree. Graduate of an accredited school of nursing with current licensure OR actively enrolled in a BSN program with completion within 3 years of hire date and graduate of an accredited school of nursing with current licensure.
YEARS OF EXPERIENCE: 3-5 years of medical/surgical nursing necessary, case management experience preferred
REQUIRED SKILLS AND KNOWLEDGE:
Experience with case management, utilization review, and discharge planning that is related to the clinical or operational functional areas.
- Knowledge and application of a wide variety of advanced case management tools and methods.
- Knowledge of clinical and operations research methodology and design. Proficient in state of the art business trends, benchmarking, and case management tools and techniques.
- Ability to operate PC based software programs or automated database management systems.
- Expertise in meeting regulatory and accreditation requirements.
- Strong presentation, written and oral communication skills, with strong analytical and problem-solving skills as well as time/project management skills.
- Ability to work with a variety of disciplines and levels of staff across departments and the organization is required.
LICENSES & CERTIFICATIONS:
Licensed to practice in the State of Ohio
Certified Case Management (CCM) or Accredited Case Management (ACM) desired.
