RN Case Manager - Coordinated Care

Job Summary

Support patients to which the RN-Case Manager I is assigned by facilitation of appropriate care coordination. The aim is to improve the efficiency in the delivery of care resulting in right care, right time, right place philosophy and practice using UMC nursing and case management model for optimal healthcare outcomes. Patient discharge planning begins upon admission and is developed through patient centric nursing process: 1) Assessment; 2) Intervention; 3) Identification of goals with expected outcomes; and 4) Evaluation

Knowledge, Skills & Abilities

Must be a critical-thinker and able to prioritize patient clinical needs effectively for successful transition into post-acute care arena. Must be able to demonstrate a proven ability to take initiative, work interdependently, problem-solve, and to meet goals and timeframes. Centers services around the clinical needs of the patient, to foster patient self-management care, and maximize efficient and cost-effective use of health resources. Advocating for the patient, payer and the healthcare organization, creating healthcare continuity and quality patient outcomes.

Behavioral and ethical standards that support and demonstrate actions in accordance with the UMC nursing model and state Board of Nursing. Complies with departmental policies/practices.

Customer service excellence recognizing and responding to patients, families, payers, staff, physicians, community resources and students as customers; timely responsiveness to referrals for assistance; act as a liaison with other departments and agencies internally and externally to ensure continuity of care transitions; and maintain up-to-date clinical knowledge/information/documentation regarding services available on a federal, state, and local level and the criteria for accessing these resources to meet clinical needs of the patient.

Responsibilities

Coordinates/ a multi-professional plan of care that addresses the general and clinical discharge needs and/or anticipates clinical needs supporting individual patient health maintenance..

Comprehensive assessment of clinical discharge needs using nursing processes and best or evidence-based practice.

Coordination of care and services, case findings, follow-up assessment/screenings, eligibility and develops monitoring schedule and evaluation related to discharge planning. Utilizes critical-thinking /clinical judgement/ and best or evidence-based practice to drive optimal outcomes.

Rounds with attending and/or resident/mid-level provider staff to identify patient plan for discharge needs providing recommendations that are clinically based and patient centric.

Works to maintain active communications in addition to timely medical record documentation with care team to effect appropriate patient management. Addresses/ resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge. Utilizes conflict resolution skills as necessary to ensure suitable resolution of issues. Collaborates to facilitate care for designated case load and monitors the patient's progress, altering discharge planning as necessary and working with outside vendors as needed. t

Organizes and facilitates access to test, procedures, and diagnostic results; to maintain or reduce general length-of-stay.

Problem solve daily issues utilizing clinical nursing knowledge and expertise to ease patient transitions through the system, seeking supervision when appropriate and presents case scenarios to supervisors on a regular basis to demonstrate clinical competencies and care transition skills/knowledge.

Actively participates on employee council as requested, researching best and evidence-based practice leading to safe outcomes for patients/families; financial sustainability for third-party payers and UMC.

Rapidly identifies opportunities to manage patients’ social determinants of health and works in tandem with social worker to mitigate risk of patient readmission or poor health outcomes.

Actively participates, collects, analyzes and reports key departmental elements, e.g. avoidable days, utilization review elements, etc.

Works to manage patient flow and safety to assure appropriate throughput, contributing to organizational financial wellbeing.

Drives appropriate policy/practice change through research, knowledge, and skills.

Arranges services to reach outcomes in specific timeframes while maintaining a holistic nursing focus based on UMC nursing care model. Includes but is not all inclusive of:

Skilled Nursing Facilities

Long-term care

Inpatient physical rehabilitation facilities

Long-term acute hospital

Group home

Home health care,

Home infusion

Enteral feedings

Home ventilators

Wound-vac

Ostomy supplies

Tracheostomy supplies

Additional activities as needed and within scope of practice

Resource Management through participation of departmental coverage to maintain adequate staffing and available consultation to patients, designee, or families; participates in 50% of monthly staff meetings within any given fiscal year; seeks to eliminate duplication among co-workers or omission of unnecessary services; determines appropriateness of utilizing hospital funds or supplies; investigates and assist patients and families in securing needed resources for financial and clinical services to ensure continuity of care with a focus on right care, right time, right place; works in tandem with coordinated care social workers and with financial counselors as needed.

The RN-Case Manager works with a sense of urgency for appropriate patient transition through utilization of teamwork, accountability, innovation, respect, ethical behavior and emotional intelligence.

Maintains an active RN license and up-to-date knowledge of third-party payer/external regulatory bodies standards, expectations and Medicare Conditions-of-Participation as it related to discharge planning/care coordination.

Management retains the right to add or change duties at any time.

Physical and Environmental Demands

Requires occasional exposure to unpleasant or disagreeable physical environment such as high noise level and exposure to heat and cold, occasional handling or working with potentially dangerous equipment, occasional exposure to biohazardous conditions such as risk of radiation exposure, blood borne pathogens, fumes or airborne particles, and/or toxic or caustic chemicals which mandate attention to safety considerations, occasional working hours significantly beyond regularly scheduled hours, occasional work produced subject to precise measures of quantity and quality, occasional bending, occasional lifting and carrying up to 25 pounds, occasional climbing, occasional crawling, occasional crouching/stooping, occasional driving, occasional kneeling, occasional pushing/pulling, occasional reaching, occasional sitting, frequent standing, occasional twisting, and frequent walking. (occasional-up to 20%, frequent-from 21% to 50%, constant- 51% or more)

Requirements

Education & Experience

Must be licensed as RN and have at least one (1) year acute care experience. Utilization management or previous case management experience preferred.

Certifications, Licenses or Registration required

Valid RN Mississippi state license, or compact-state license or eligible for transfer of RN license to state of Mississippi. Accredited Case Manager Certification (ACMC) or Certified Case Manager (CCM) preferred but not required. Candidate will plan to achieve specialty certification within 48-months of hire date.