RN Care Manager, 3 Surgical Step Down, 40 Hours (Days / Rotating Weekends)

POSITION SUMMARY

Utilizing a collaborative process, the care manager will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual’s health needs, using communication and available resources to promote quality, cost-effective outcomes. The care manager helps identify appropriate providers and facilities throughout the continuum of services while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the patient and the reimbursement source.

The care manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include:

Assessment - The care manager will collect in-depth information about a person’s situation and functioning to identify individual needs in order to develop a comprehensive care management plan that will address those needs.

Planning – The care manager will determine specific objectives, goals, and actions as identified through the assessment process. The plan should be action oriented and time specific.

Implementation – The care manager will execute specific intervention that will lead to accomplishing the goals established in the care management plan.

Coordination – The care manager will organize, integrate, and modify the resources necessary to accomplish the goals established in the care management plan.

Monitoring – The care manager will gather sufficient information from all relevant sources in order to determine the effectiveness of the care management plan.

Evaluation – At appropriate and repeated intervals, the care manager will determine the plan’s effectiveness in reaching desired outcomes and goals. This process might lead to a modification or change in the care management plan in its entirety or in any of its component parts.

Position: RN Care Manager

Department: 3 Surgical Step Down

Schedule: 40 Hours (Days / Rotating Weekends) 10 Hour Shifts

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Conduct a thorough and objective evaluation of the client’s current status including physical, psychosocial, environmental, financial, and health status expectation. As a client advocate, seek authorization for care management from the recipient of services (designee). Coordinates/facilitates patient care progression throughout the continuum.

• Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary care team to effect timely, appropriate patient management.
• Ensures appropriate clinical pathway assignment by staff nurses
• Addresses/resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies and resolves delays and obstacles to discharge.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated caseload; monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis:Completion and reporting of diagnostic testingCompletion of treatment plan and discharge planModification of plan of care, as necessary, to meet the ongoing needs of the patientCommunication to 3rd party payers and other relevant information to the care teamAssignment of appropriate levels of careCompletion of all required documentation in TQ screens and patient records

Maintain communication and collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Completes utilization management and quality screening for assigned patients.

• Applies approved utilization acuity criteria to monitor appropriateness of admissions and continued stays and documents findings based on department standards.
• Identifies at-risk populations using approved screening tool and follows established reporting procedures
• Monitors length of stay (LOS) and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
• Assess resource utilization and cost management; the diagnosis, past and present treatment; prognosis, goals (short-and long-term).
• Refers cases and issues to physician advisor in compliance with department procedures and follows up as indicated.
• Communicates with resource center to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Uses quality screens to identify potential issues and forwards information to the quality review department.
• Identify opportunities for intervention
• Set goals and time frames for goals appropriate to the individual.
• Arrange, negotiate fees for, and monitor appropriate cases and services for the client.

Ensures that all elements critical to the plan of care and clinical path have been communicated to the patient/family and members of the health care team and are documented as necessary to ensure continuity of care. Manages all aspects of discharge planning for assigned patients.

• Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with the physician.
• Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Ensures/maintains plan consensus from patient/family, physician, and payer.
• Refers appropriate cases for social work intervention based on department criteria.
• Collaborates/communicates with external care managers.
• Initiates and facilitates referrals through the resource center for home health care, hospice, and medical equipment and supplies.
• Documents relevant discharge planning information in the medical record according to department standards.
• Facilitates transfer to other facilities for care management population.

Actively participates in clinical performance improvement activities.

• Assists in the collection and reporting of 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 care management for assigned patients, including fiscal, clinical, and patient satisfaction data.
• Establish measurable goals that promote evaluation of the cost and quality outcomes of the care provider.
• Collects, analyzes, and addresses variances from the plan of care/care path with physician and/or other members of the health care 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 the director of outcomes management.
• Documents key clinical path variances and outcomes that relate to areas of direct responsibility (e.g., discharge planning). Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
• Participates in the development, implementation, evaluation, and revision of clinical pathways and other care management tools as a member of the clinical resource/team. Assists in the compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction, and quality indicators (e.g., readmission rates, unplanned return to OR, etc.).
• Report quantifiable impact, quality of care and/or quality of life improvement as measured against the care management goals.

Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided. Utilizes hospital's Values as the basis for decision-making and to facilitate the division's hospital mission. Follows established hospital infection control and safety procedures.

OTHER DUTIES:

Provide coverage for Emergency Department, and/or other unit-based Care Managers, as directed. Perform other duties as needed.

The above statements are intended to describe the nature and level of work performed. They are not intended to be construed as an exhaustive list of all duties required of personnel so classified. Employees may be assigned to other duties as required.

JOB REQUIREMENTS

EDUCATION

• Nursing degree: Graduate of an accredited BS Program in Nursing

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED

• Licensed to practice professional nursing as a Registered Nurse in the Commonwealth of Massachusetts by start date
• CCM or related certification attained within 24 months from hire date is preferred

EXPERIENCE

• A minimum of 1-3 years of recent acute, Inpatient Care Management experience required or successful completion of the Care Management Nurse Residency Transition Program by start date.
• A minimum of 2 years of previous experience involving judgement and decision making, preferably in a utilization management/case management position

KNOWLEDGE AND SKILLS

• Extensive background and knowledge of current medical/surgical patterns of practice.
• Medical terminology and standard medical abbreviations.
• Managed care concepts, the various health care delivery systems
• Methods for assessing an individual are level of physical/mental impairment, understanding of the physical and psychological characteristics of illness, and understanding of expected treatment.
• Confidentiality issues and the legal and ethical issues pertaining to them.
• ICD-10 and CPT nomenclature and the ability to interpret and convert this information, as applicable.
• Knowledge of benefits and various plan contracts, eligibility issues and requirements.
• Role and functional responsibilities of case management professional; case management program philosophy and purpose within Managed Care Program
• Excellent interpersonal, verbal and written communication and negotiations skills
• Strong analytical, data management and PC skills

An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

NursingCM

Compensation Range

$38.05- $75.33

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, and licensure/certifications directly related to position requirements. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), contract increases, Flexible Spending Accounts, 403(b) savings matches, earned time cash out, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Equal Opportunity Employer/Disabled/Veterans

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