Case Manager RN RGV

Case Manager

The Case Manager is responsible for evaluating, coordinating, and implementing the functions of Utilization Review and Discharge Planning in order to coordinate: (1) quality of patients care, (2) cost effective outcome management, (3) communication between patients, families, and members of the healthcare team, (4) facilitation of movement of patients through appropriate levels of care, (5) activities and equipment necessary to transition to home.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.

Maintains utmost level of confidentiality at all times.

Adheres to hospital policies and procedures.

Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.

Identifies patients who need discharge planning services.

Identify high risk or potential problematic cases based on predetermined internal trigger mechanisms.

Develops and reviews each stage of care, analyzes patterns of variance and implements strategies to resolve them.

Documents resource management activities separately from the medical record.

Involves patient caregiver in plan of care, allowing family to be as independent as possible with plan of care; therefore, ensure cost effective care.

Assess patient/family needs thoroughly.

Reassesses patient/family needs as needed.

Cross training and ability to perform the essentials duties of UR/CM as needed.

Participates in regular peer discussions and collaboration regarding the management of the caseload and seeks peer consultation about cases that are presenting problems and/or significant variances.

Collaborates closely with Social Workers to ensure effective communication and planning for patients needs.

Participates in quality improvement activities to improve the delivery of high-qualify, cost-effective patients care as evidenced by documentation, observed behavior. And verbal written feedback.

Maintains professional standards through licensure, certification, education, and development.

Consults with hospital staff and physicians regarding patient's continuity of care needs.

Identifies best practice patterns based on comparative data.

Documents discharge planning activities in the medical record.

Collaborates and communicates with providers, members of healthcare team, payers, patients and family members for purposes of coordinating care, understanding needs of families and payers and for identification of healthcare needs that extends beyond the hospital stay.

Demonstrates working knowledge of payer and accrediting agencies.

Participates in family conference when indicated, and acts as a liaison between hospital and community agencies when making referral for DME, nursing care, supplies or therapy.

May be involved in nursing or hospital-wide committee for program development and information sharing.

Bachelor's degree (B. A.) from four-year College or university; or one to two years related experience and/or training; or equivalent combination of education and experience.

Associate's degree (A.D.N.) with five years related experience required.

Bilingual skills in Spanish preferred.

Registered and currently licensed by the Board of Nurse Examiners for the State of Texas. Current CPR certification. National certification in applicable are to be obtained with 2 years of eligibility.