Inpatient Care Manager

MAJOR RESPONSIBILITIES

• 
  
  

  
  
  
  
  
  Conducts complete assessments,
  
  
  
  
  establishes
  
  
  
  
  
  
  appropriate plans
  
  
  
  
  , and initiates interventions within desired
  
  
  
  
  timeframes
  
  
  
  
  . Collaborates and negotiates effectively with
  
  
  
  
  patient
  
  
  
  
  , family, and
  
  
  
  
  team
  
  
  
  
  while striving to achieve patient and organizational goals
  
  
  
  
  with regard to
  
  
  
  
  
  
  patients
  
  
  
  
  care needs,
  
  
  
  
  choice
  
  
  
  
  and satisfaction when discharge planning/transitioning care. Utilizes patient/family strengths in the problem-solving process, involving the patient/family and team in the decision-making process
  
  
  
  
  beginning on
  
  
  
  
  admission and continuing throughout patients hospital stay.
  
  
  
  
  
  
  
  

  
  

• 
  
  

  
  
  
  
  
  Provides continuity of care and discharge planning services compliant with regulatory standards by
  
  
  
  
  providing
  
  
  
  
  coordinated relevant options and services based on assessed needs to ensure patient/family and healthcare team is informed and able to
  
  
  
  
  proceed
  
  
  
  
  with accountabilities
  
  
  
  
  in a timely manner
  
  
  
  
  . This includes participating in the communication process to
  
  
  
  
  facilitate
  
  
  
  
  a smooth transition for
  
  
  
  
  patient
  
  
  
  
  , family, and staff when patients are transferred.
  
  
  
  
  
  
  
  

  
  

• 
  
  

  
  
  
  
  
  Provides case management services related to various levels of health care, finances, housing, family discord, or illness adjustment, based department scope. This may include managing family dynamics and crisis situations in
  
  
  
  
  a timely
  
  
  
  
  and professional manner, using community resources effectively, and educating patient/family
  
  
  
  
  regarding
  
  
  
  
  access to and use of services.
  
  
  
  
  
  
  
  

  
  

• 
  
  

  
  
  
  
  
  Initiates internal and external referrals to
  
  
  
  
  assure
  
  
  
  
  
  
  timely
  
  
  
  
  progression of care and transitions.
  
  
  
  
  Documents
  
  
  
  
  discharge planning interventions and
  
  
  
  
  utilization
  
  
  
  
  review activity per department and medical center standards
  
  
  
  
  in a timely manner
  
  
  
  
  . Performs and documents
  
  
  
  
  accurate
  
  
  
  
  and
  
  
  
  
  timely
  
  
  
  
  concurrent and retrospective reviews based on approved established criteria as required by department standards.
  
  
  
  
  
  
  
  

  
  

• 
  
  

  
  
  
  
  
  Communicates effectively with the healthcare team. Works in partnership with Social Work and unlicensed support personnel to effectively
  
  
  
  
  establish
  
  
  
  
  and implement a safe plan of care. Serves as an active member of the MDR and works closely with medical staff, hospital departments and ancillary services in identification and resolution of barriers to discharge, expediting care delivery to avoid delays in timely service provision, and implementing and reporting care coordination, discharge planning and utilization management (UM) activities.
  
  
  
  
  
  
  

• 
  
  

  
  
  
  
  
  Collaborates with managers, physicians, medical directors, advisory groups, and treatment teams for issues related to physician practices and best practices for the patients plan of care.
  
  
  
  
  Refers cases
  
  
  
  
  to physician
  
  
  
  
  advisor
  
  
  
  
  as needed to ensure efficient progression of care,
  
  
  
  
  accurate
  
  
  
  
  status, and compliance with regulatory guidelines.
  
  
  
  
  
  
  
  

  
  

• 
  
  

  
  
  
  
  
  Remains knowledgeable in issues of healthcare regulations, reimbursement issues, impact on length of stay and community resources. Completes UM activities as
  
  
  
  
  required
  
  
  
  
  based on local structure to include providing clinical updates to payers and/or external review organizations, collecting data, coordinating denial activity, supporting UM activity, and managing avoidable delays.
  
  
  
  
  Delivers
  
  
  
  
  CMS regulatory notices within CMS
  
  
  
  
  established
  
  
  
  
  
  
  timeframes
  
  
  
  
  , as
  
  
  
  
  appropriate based
  
  
  
  
  on-site guidelines.
  
  
  
  
  
  
  
  

  
  

• 
  
  

  
  
  
  
  
  Develops and
  
  
  
  
  maintains
  
  
  
  
  productive relationships with community-based agencies and networks by
  
  
  
  
  representing
  
  
  
  
  Advocate Health Care in a positive manner working collaboratively, internally, and externally, to meet patient/family needs. Works in collaboration with Advocate Ambulatory Care Management and Continuing Health to meet common goals and outcomes.
  
  
  
  
  
  
  
  

  
  

• 
  
  

  
  
  
  
  
  Serves as an educator and expert resource to medical and hospital staff
  
  
  
  
  regarding
  
  
  
  
  admission status and acute care criteria,
  
  
  
  
  utilization
  
  
  
  
  management issues, care coordination and discharge planning needs, and relevant regulatory requirements.
  
  
  
  
  
  
  
  

  
  

• 
  
  

  
  
  
  
  
  Must be able to
  
  
  
  
  demonstrate
  
  
  
  
  knowledge and skills necessary to provide care
  
  
  
  
  appropriate to
  
  
  
  
  the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.
  
  
  
  

  
  

Education:

Graduate of a Board of Nursing approved nursing education program (RN)

Preferred Bachelor of Science degree in Nursing (BSN).

License/Registration/Certification:

Current RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside or if declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state; or for Non-National License Compact states, (where applicable) current RN license or temporary license as a Registered Nurse

Years of Experience:

Typically requires




3 years of related nursing experience. Clinical experience within the assigned population




.




Extensive knowledge of disease processes and clinical outcomes. Case Management experience or background preferred. Strong critical thinking and analytical skills




preferred




. Appropriate Professional certification




preferred




within 3 years of hire

KNOWLEDGE SKILLS AND ABILITIES

Ability to prioritize and organize work.

Effective communication skills.

Utilization of critical thinking and timely decision making.

Ability to navigate the Electronic Health Record.

Basic utilization of MS Office products.

Knowledge of Medicare A and B guidelines.

Knowledge of Managed Care program requirements/implications.

Ability to apply elements of Utilization Management programs.

Physical REQUIREMENTS

Must be able to sit up to approximately 50 percent of the workday; stand and walk for the equivalent of several blocks at a time.

Must lift up to 10 lbs. continuously, up to 20 lbs. frequently, and up to 50 lbs. occasionally.

Manual dexterity required for operation computer and calculator.

Visual acuity required for facilitating review of written documents/computer screens, medical records, and to record information accurately.

Clear verbal communications and hearing acuity required for receiving instructions and converse on standard telephone.

Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone.

Exposed to normal office environment; including usual hazards related to operating electrical equipment.

Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.


Advocate Health