NURSE CASE MNGR-RN Inpat

Job Description

Job Description

Overview

The purpose of the Case Manager position is to communicate and facilitate care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self-determination through a collaborative practice model including patients, nurses, social workers, physicians, other practitioners, caregivers, and the community.

Position Reports To: Director of Inpatient Nursing

Responsibilities

1. The Case Manager is accountable for a designated patient caseload and works with patients/families/caregivers and the health care team to jointly communicate, problem solve and share accountability for optimal outcomes. These outcomes respect patient preferences and their available resources. Specific functions within this role include:

   • Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.

   • Application of process improvement methodologies in evaluating outcomes of care.

   • Coordinating communication with physicians.

2. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the patient served. Must demonstrate knowledge of the principles of growth and development as it relates to the different life cycles. Promotes culturally competent care.

   • Ensures the development of a safe and effective plan of care through early identification and thorough assessment of the patient’s needs and the resources available.

   • Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.

   • Provides patient/family/caregivers available tools/resources to make informed choices. Demonstrates the ability to balance resources with patient preferences.

   • Educates patient/families/caregivers and health care team on the economic impact of their care options.

   • Arranges services among community agencies, physicians, patient/family/caregivers, and others involved in the plan of care.

   • Monitors progress toward the goals of the plan and ensures revisions in response to changes in patient needs and condition intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective

   • Address/resolves system problems impending diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles. Utilizes an organizationally defined escalation process to refer facets of the care plan beyond the control or influence of the team.

   • Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.

     Facilitates the progression of care by advancing the care plan to achieve desired outcomes and integrates the work of the health care team by coordinating resources and services necessary to accomplish agreed-upon goals.

3. Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.

4. Completes Quality Screening for assigned patients.

   • Identifies at-risk populations using approved screening tool and follows established reporting procedures.

   • Refers case and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.

   • Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.

   • Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.

5. Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.

   • Collaborates/communicates with internal & external case managers.

   • Initiates and facilitates referrals for home health care, hospice, medical equipment and supplies.

   • Facilitates transfer to other facilities as appropriate.

6. Actively participates in clinical performance improvement activities.

   • Assists in the collection and reporting of resource and financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.

   • Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data.

   • Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team. Uses concurrent variance data to drive practice changes and positively impact outcomes.

   • Collects delay and other data for specific performance and/or outcome indicators as determined by Director or Manager of Case Management.

   • Documents key clinical path variances and outcomes which relate to areas of direct responsibility. Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.

7. Ensures safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.

8. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as a preceptor, mentor, and resource to less experienced staff.

9. Required to maintain active Basic Life Support (CPR) certification.

10. Performs other duties as assigned.

Demonstrate Standards of Behavior and adhere to the Code of Conduct in all aspects of job performance at all times.

Qualifications

Required:

• One to three years clinical experience.
• Current licensure in the state of Washington (RCW 18.88) (AD or BSN) or licensure through Multistate Nurse Licensure Compact (SSB 5499).
• Basic Life Support certification (within 90 days of hire).
• Professional certification as a Case Manager encouraged within two years of employment.
• Excellent interpersonal communication and negotiation skills.
• Strong analytical, data management and PC skills.
• Understanding of venues of care and community resources.
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.
• Performs duties in a manner to promote quality patient care and customer service/satisfaction, while promoting safety, cost efficiency, and a commitment to the CQI process.

Desired:

• Not specified.