Case Manager

Case Manager

The Case Manager is accountable for coordinating the care and service of selected patient population across a continuum of care; ensuring and facilitating the achievement of optimal quality, clinical and cost outcomes; coordinating services and resources needed by the patient and family; and assuming a leadership role with the multidisciplinary team.

Responsibilities

Coordinates and collaborates with physicians, provider, multidisciplinary team and other health care professionals concerning patient's goals, plan of care and progress.

Develops, implements, interprets and maintains work standards and procedures that are in compliance with ARH's policies and governmental regulations and various regulatory agency requirements.

Maintains up-to-date knowledge in the field to allow recommendation of new services, products and equipment.

Assesses, develops, implementation, and monitors comprehensive plan of care through an interagency multi-disciplinary team process in conjunction with the patient and family internal and external settings.

Revises and adjusts on a daily basis the plan of care to accommodate the needs of the individual patient based on continuing assessment of patient condition.

Assumes responsibility and accountability for the care plan and effectiveness and patient outcomes.

Assesses the appropriateness of the level of care; diagnostic testing and clinical procedures; quality and clinical risk issues; and documentation of medical record completeness.

In accordance with hospital sanctioned ISDA criteria and/or other established criteria, reviews all patient admission data to determine the suitability of the level of care.

Develops, implements, monitors and evaluates clinical pathways and clinical pathway variances.

Monitors patients progression through clinical pathways.

Communicates continually with patients, families, medical staff, caregiver and third-payors as necessary.

Assists the patients and families with the educational process prior to admission, during hospital stay and after discharge, as indicated.

Assures patients understand the third-party payer guidelines and to arrange discharge planning referrals as ordered by patients' physicians.

Develops and maintains a positive work climate and supports the overall team effort of the hospital.

Assists in collecting and analyzing outcome data.

Performs other duties as assigned or directed.

Qualifications

Education

• BSN preferred with 5 years experience in a hospital/community setting; OR

• Must complete BSN or degree in other related field within 5 years; OR

• RN with MSN or degree in other related field with 3 years experience;

Licenses & Certifications

• Must meet all Licensure and Certification requirements in state working; OR

• Must obtain Certification of Case Management Society of America.

• Must have a valid driver's license in state working.

Required Skills, Knowledge & Abilities

• Excellent oral and written communication skills.

• Must possess skill and proficiency in applying highly technical principles, concepts and techniques that are central to the nursing profession.

• Excellent organizational skills.

• Must travel to patients' residences, agencies, and network providers as necessary.

• Required to be cross-trained in UR, QA, discharge planning, and infection control.