RN Case Manager

Work Status Details: Full Time | 80.00 Hours Every Two Weeks

Exempt from Overtime: Non-Exempt

Shift Details: Week days, weekend/Holiday rotation

Department: Care Management | Reports To: Supervisor-Case Manager RN

The mission of Faith Health is to serve Christ by providing all people with exemplary medical services in an environment of love and care.

Summary:

The registered nurse (RN) is a professional nurse under the supervision and direction of the department manager/director. The RN works within the state defined scope of practice and adheres to department and hospital policies/procedures and regulatory requirements.

The Case Manager RN is responsible for coordinating and assuring optimum care delivery to an identified patient caseload. Identifies physical and psychological factors that could potentially increase the patients' morbidity/mortality. Monitors resource consumption and evaluates cost/benefit to assure effective and efficient utilization of hospital resources. Promotes and provides for optimum patient outcomes through use of Care Management concepts. Utilizes community resources to facilitate meeting the demands of the patient/family or significant other. Participates in the coordination of the development of the Clinical Care Management Program.


The Nurse Case Manager collaboratively assesses, plans, coordinates, monitors and evaluates patients' treatment plans to promote effective utilization of services throughout the continuum of care and to ensure quality outcomes. The Nurse Case Manager monitors the patient care process and collects data to evaluate and improve care and collaborates with physicians and other health care workers to provide comprehensive care including health risk appraisal, health promotion and clinical outcome studies. This role serves as an educator for payers, providers and the public and serves as the information source regarding state and national health care trends; initiatives, which enhance the provision of, care and ensure efficient resource utilization.

The Case Manager utilizes nursing process for assessing, planning, implementing, and evaluating patients. The care delivered is individualized and goal directed. The RN is responsible for delegated tasks. The RN works cohesively and collaboratively with providers and other interdisciplinary health care team members to provide high quality and safe care.


The listing of job duties contained in this job description is not all inclusive. Duties may be added or subtracted at any time due to the needs of the organization.

Responsibilities:

Essential Job Duties and Responsibilities:

1. Demonstrates ability to appropriately modify approach and procedures to meet needs of age/diversity of population served for the following age groups:


☒ Neonate (birth - 28 days)


☒ Infant (29 days - less than 1 year)


☒ Pediatric/Child (1 year - 12 years)


☒ Adolescent (12 years - 18 years)


☒ Adult (18 years - 65 years)


☒ Geriatric (over 65 years)
• Incorporates cultural considerations in the provisions of care.
• Knowledge of growth and developmental stages.
• Considers life changes/effects on health beliefs and behaviors.
• Provides necessary safety measures.
• Provides information and involves family/caregiver in decision making.


2. Performs all responsibilities/duties of a Case manager and/or Role Specific duties include:
• Establishes treatment goals that meet the patients' health care needs and the referral source requirements
• Assess clinical information to develop treatment plans through frequent rounds and communication with direct nursing caregivers, physicians, and other members of the health care team.
• Assures the progress pathway/patient plan of care is initiated within 24 hours of admission identifying individualized patient goals/expected outcomes.
• Communicates case objectives to individuals involved in providing care to optimize compliance with the plan of care and intervenes when variances occur in the patient's individualized plan of care.
• Responsible for the Utilization Management activities for assigned patients. Applies approved screening criteria to monitor appropriateness of admissions and continued stays and documents findings based on departmental standards.
• Monitors length of stay and works with care team to timely progress patient through plan of care.
• Acts as a resource on complex care activities.
• Identifies and directly addresses issues that affect patient care outcomes, collaborates with appropriate providers to prevent recurrence of issues.
• Establishes networks and referral sources to maximize utilization of available community/regional resources.
• Provides nursing and discharge planning expertise in collaboration with other health care professionals, especially the primary care physician and specialists if required. Refers appropriate cases for Social Services intervention based on department criteria.
• Coordinated complex discharge services with Social Services throughout the continuum, communicating pertinent information of patient's progress to social services, who will arrange/coordinate appropriate referral sources, alternative level of care and community agencies.
• Identifies cases with potential for high-risk complications and initiates a preventive plan of care.
• Acts as an advocate for an individual's health care needs.
• Understands the physical and psychological characteristics of the disease process in the service specialty and utilizes this knowledge to coordinate resources to meet the needs of the patient.
• Understands the psychological characteristics of wellness to optimize the patient's functional level.
• Works with patients and families to assist them in understanding and participating in the development of the plan of care.
• Delivery of Important Message from Medicare (IMM), Condition Code 44 notices and Hospital Issue Notice of Non-Coverage as appropriate.
• Assesses post hospital medical, social, and financial needs, working with the patient/family/significant other in obtaining assistance in meeting the needs.
• Evaluates the quality of services and communicates any concerns related to the service path/plan of care to the attending physician or other members of the health are team.
• Maintains familiarity with laws, regulations, and interpretation of the same as relates to utilization review, care coordination and discharge planning.
• Demonstrates the understanding of requirements for pre-certification process by payers.
• Identifies cases that would benefit from alternative care and makes appropriate recommendations to the attending physician or payers as needed.
• Acquires data necessary to conduct review of the care delivery for the purpose of managing the length of stay and resource consumption.
• Monitors plan of care, collects and analyzes variance data to modify the plan of care as necessary.
• Acts as a liaison between third party payers, health care team and patient/family/significant other.
• Coordinates, with third party payers, the progress toward established treatment goals in the most cost-effective way.
• Provides routine verbal and written documentation of the initial assessment and progress of the individual patient to the payer and/or appropriate other on a timely basis.
• Documents effectiveness of Care Management services, utilizing Care Management logs, variance analysis theory and PI monitoring.
• Applies advanced problem-solving techniques in planning, assessing, implementing and evaluation of patient care.
• Understands the Care Management philosophy and principles of Interdisciplinary Team management and collaborative practice.
• Demonstrates the ability to evaluate the effectiveness of Care Management utilizing the PI process to evaluate patient outcomes.
• Utilizes tools and resources, (clinical paths, screening tools, protocols, databases) to develop a comprehensive plan of care.
• Demonstrates an understanding of planning and goals development techniques.
• Intervenes when variances occur in the patient's individualized plan of care appropriately documenting the variances (avoidable days).
• Demonstrates an understanding of interviewing techniques, obtaining information needed for the plan of care from patient/family/significant other.
• Demonstrates ability to explain services and available resources (including limitations) to individuals with disabilities.
• Organizes and develops a patient's support system to facilitate an effective transition to another appropriate level of care.
• Demonstrates knowledge of assistive devices needed by individuals with disabilities.
• Demonstrates an understanding of the patient's needs for religious and vocational services.
• Collaborates with physicians and staff in developing needed patient education materials.
• Coordinates/facilitates interdisciplinary patient care conferences for patient population.
• Performs screens at the time of admission or within 24 hours to identify patients with potential complex discharge needs, palliative care referrals.
• Utilizes variance information (avoidable days) to evaluate and refine service care delivery.
• Plans, coordinates and facilitates patient care conferences, patient care rounds and PI teams.
• Conducts informal/formal staff education.


3. Assumes all other duties and responsibilities as necessary.
• Maintains confidentiality per policy.
• Maintains current competency by attending department and hospital based educational offerings either in person or online.
• Actively engages in department activities and team meetings and attends required meetings.
• Demonstrates active engagement in department activities and evidence-based initiatives.
• Demonstrates dependability/flexibility in meeting scheduling needs of the department and hospital.
• Accepts assignment of preceptor for new staff.
• Accepts responsibility for mentoring healthcare students.


Hours will be dependent on patient census and workload. Ability and willingness to work a flexible schedule, to include after-hours and weekends as necessary.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other information:

Job Requirements:

The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required.


EDUCATION:

Graduate of an accredited school of nursing required.

Bachelor's Degree preferred.

CERTIFICATES, LICENSES, REGISTRATIONS:

Current Registered Nurse (RN) license or temporary permit from the State of Nebraska required.

Previous Experience Requirements:

EXPERIENCE:

Previous clinical experience preferred.

Experience with transitions of care preferred.

Previous experience in acute care nursing or similar background preferred.

Skills/Knowledge Requirements:

SKILLS:

Language Skills - Ability to read, write, speak, and understand the English language required.

Faith Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.