RN Case Manager - Omaha (FT Days, Mon-Fri)

Case Management-Omaha

Full Time - Day

Job Description

JOB DESCRIPTION
Job Title: RN Case Manager Job Code: 800010
Immediate Supervisor: Senior Director Case Mgmt- Hospital Programs Status: Non-exempt
DEPARTMENT FUNCTION/JOB OVERVIEW
The Case Manager is responsible for the collaborative team process which assesses plans, implements, coordinates, monitors and evaluates the options and services to meet the patient’s health needs, using communication and available resources to promote quality, cost effective outcomes. These duties include the development of the patient’s overall plan of care including the identification, periodic review and revision, and communication of an individualized interdisciplinary plan of care. The case manager is accountable for meeting quality patient outcomes and service delivery based on (1) appropriate length of stay, (2) effective utilization of resources including program utilization, (3) continuity through a continuum of care, and (4) established standards. Additional responsibilities include serving as a liaison between patient, family, payer, team and physician; facilitation of education and training for patients, families and caregivers; for overall coordination of the patient’s program. The case manager must adhere to the CARF standards for a case manager. Work will be performed in an ethical and legal manner following organizational policies, processes, protocols and procedures. Responsible for quality service delivery and internal/external customer relations for Madonna as a whole, including upholding the mission and values for the department and facility.

• Analyze patients past and current status; assess impairments, disabilities and handicaps in order to plan, coordinate, implement and monitor an effective and efficient plan of care.
• Analyze and monitor patient’s need for specialized tests, equipment, transportation, etc., in order to coordinate the provision of and payment for such services.
• Monitor the patient’s current status as well as information in the medical record, and assimilate/compare to professional nursing knowledge of disease, trauma or disability to evaluate and ensure the appropriate provision of care.
• Analyze, assess and monitor the principal diagnosis, secondary diagnoses, and procedures assigned to the patient to evaluate and ensure accurate reimbursement in hospital programs.
• Analyze, assess and monitor the Patient Based Income Statement (PBIS) to obtain CMG or DRG length of stay to assist in the management of the patient’s length of stay and manage patients’ financial information in order to maximize appropriate utilization of resources.
• Compile, coordinate and analyze patient’s program information in accordance with the requirements of third party payers in order to maximize appropriate utilization of patient’s financial benefits.
• Coordinate and compile information regarding patient’s status and outcomes, unplanned discharges and patient follow up to assess customer satisfaction, facilitate problem resolution, and contribute to evaluation of the program.
• Compile and analyze information to monitor patient’s response to the current treatment plan, assess available, clinically and financially appropriate alternatives in order to plan and implement appropriate placement in the continuum of care.
• Compile and analyze patient, program and facility clinical and financial data in order to evaluate and improve patient outcomes, and maintain program viability.
• Coordinate and compile patient information in order to ensure that discharge arrangements are completed and facilitate the implementation of discharge recommendations, ensuring documentation meets all regulatory requirements
• Mentor, instruct and communicate with patients and patient representatives in order to orient them to the program services, admission and discharge criteria and patient/family responsibilities in order to ensure patient/patient representative active participation in the program.
• Mentor, instruct and speak with patients and patient representatives regarding financial information in order to maximize informed decision-making.
• Speak with patients/patient representatives and other customers regarding concerns/grievances and facilitate resolution in order to ensure customer satisfaction.
• Mentor, instruct and speak with patients and patient representatives regarding discharge/transition arrangements in order to maximize patient outcomes, and appropriate utilization of the continuum of care.
• Mentor, instruct and speak with members of the interdisciplinary team in order to plan, implement, coordinate, monitor, evaluate and document the patient plan of care.
• Mentor, negotiate, instruct and speak with members of the interdisciplinary team in order to monitor and resolve issues related to the plan of care in order to maximize customer satisfaction, patient/family participation and efficient, effective care delivery.
• Communicate with the interdisciplinary team and business staff regarding patient’s financial information in order to coordinate, monitor and evaluate appropriate program development, modification and efficient financial management.
• Negotiate, instruct and speak with internal and external physicians and other service providers regarding patient’s progress, needs and program goals in order to coordinate and evaluate the program to maximize patient outcomes and/or responsible utilization of resources.
• Negotiate, instruct and speak with external case managers or work within external payer authorization portals regarding patient’s clinical program in order to coordinate and evaluate the program, maximize patient outcomes, and appropriate utilization of resources.
• Negotiate, instruct and speak with interdisciplinary team and other stakeholders in order to ensure that discharge arrangements are complete and facilitate the implementation of discharge recommendations.
• Communicate with team members, patients, patient representatives and other stakeholders to coordinate follow up in order to ensure customer satisfaction.
• Communicate and collaborate with Case Management supervisor and/or the Director of Case Management and other appropriate staff regarding difficult case situations and/or interdisciplinary team difficulties in order to assess, monitor and evaluate quality service delivery.
• Follow instruction from the Case Management Supervisor, the Director of Case Management and/or the administrative personnel to perform other functions as assigned in order to achieve the goals within the department and Madonna as a whole.
• Negotiate with the Social Worker to ensure the primary Social Work’s functions are coordinated for continuity of care in the Social Worker's absence.
• Operate telephone, video conferencing equipment photocopy machine, fax machine, personal computer and calculator in order to communicate with necessary internal and external people and agencies and to compile patient information.
• Maintains a clean, organized and safe environment while handling all necessary equipment, performing required duties according to established safety standards , and maintaining compliance with regulations to prevent injury.

PHYSICAL DEMANDS AND ENVIRONMENTAL CONDITIONS

Physical requirements: Frequent sitting, standing and walking, occasionally lifting/carrying less than 10 pounds, frequently handling paper, pens, dictation equipment, telephone and personal computer. Frequently talking and hearing ordinary tones for conversational speech in person and on the telephone, frequently seeing handwritten and printed and on-screen material. Near vision acuity is required for reviewing medical records and documenting.

QUALIFICATIONS

Must be a Registered Nurse with current Nebraska RN licensure. Must have a minimum of 18 months clinical experience, one year of which must be in physical rehabilitation. CCM preferred. Experience in medical case management or team facilitation preferred. General knowledge of Medicare and Medicaid programs and basic knowledge of indemnity and managed care insurance required. Knowledge of general rehabilitation principles, community resources, and group dynamics required. Must possess effective skills in negotiation, group facilitation, conflict management and consensus building. Must possess well-developed written and verbal communication and problem solving skills. Must possess and maintain current licensure/certification in area of clinical practice.

Background checks are conducted. When specific authorization forms are requested so that full background and history can be obtained, employees/applicants must sign the form(s) requested.

Requirements

The following are requirements in addition to any stated in the above description.

Licenses

You must have the following licenses to apply: