RN - Case Management

JOB SUMMARY:

Manages and monitors care for an assigned patient population and provides clinical and educational support to ensure that quality and cost-effective care is provided. Collaborates with patients by assessing, facilitating, planning and advocating for health needs on an individual basis. Assist in development, analysis and evaluation of Evidence Based Medicine, in cooperation with other hospital personnel, provides appropriate and timely discharge planning with referrals to Social Services as indicated. Exhibits the F.I.R.S.T. values (Friendliness, Innovation, Respect, Service and Trust).

ESSENTIAL FUNCTIONS, DUTIES AND RESPONSIBILITIES:

1. Evaluates appropriateness of nursing, medical and ancillary care of all assigned patients to decrease unnecessary tests/procedures and days admitted to the hospital: Facilitates the health delivery process to focus on the best practices based on Evidence Based Medicine in order to minimize unnecessary steps in the delivery of care.
2. Evaluates daily assigned patient's status and progress toward reaching goals in the plan of care (POC) and makes adjustments in care/services to enhance positive outcomes and improve average length of stay (ALOS).
3. Daily communication with Physicians acting as liaison between all care disciplines and other consulting physicians to facilitate and expedite all necessary treatment in order to decrease Physician ALOS.
4. Appropriately assign the status of inpatient versus observation based on InterQual criteria from day one of admission. Communicate with Executive Health Resources (EHR) physician adviser when unable to qualify patient as inpatient based on Interqual criteria.
5. Reviews and develops as assigned departmental policies and procedures to reflect current practices in case management.

CLINICAL

1. Makes daily rounds with physicians on assigned unit and meets with Hospitalist Group to discuss POC and discharge disposition.
2. Meets daily with Charge Nurse to discuss and identify barriers to discharge for assigned patients.
3. Demonstrate competency yearly with a score of >90% on Interqual testing.
4. Utilize Interqual guidelines and criteria to perform review of each assigned patient's activities assuring proper utilization of Organizational services based on Medicare guidelines. Review assigned inpatient medical records to qualify for admission, and continued stay based on medical necessity. Maintains documentation of such reviews daily.
5. Utilizes and documents Physician Adviser referrals made appropriately. Trends results of Physician Adviser review and outcomes. Updates log of communication and submits to the Director quarterly.
6. Collects Potential Avoidable Day (PAD) variances related to timeliness of services, results of services and patient/family compliance/cooperation and documents appropriately to be submitted to the director quarterly.
7. Identifies Core Measure patients upon daily reviews and documents in Meditech.
8. Represents Case Management with Performance improvement groups monthly or as necessary to monitor and improve core measures. Development of policies based on Evidence Based Medicine to improve core measure outcomes and increase dashboard percentages.

RELATIONSHIP

1. Promotes communication between all disciplines, patients, families, physicians, and external agencies through accurate and timely documentation.
2. Decreases % of physician complaints regarding timeliness of consults for Case Management with accurate and timely documentation and communication with said physician.

SAFETY

1. Adheres to safety and disaster drills.
2. Preforms department safety checks as assigned, completed monthly.
3. Maintains patient confidentiality of identification and information by adhering to HIPPA guidelines.

Additional Essential Job Duties

1. Demonstrates a commitment to professional accountability and growth to maintain and expand knowledge and skills.
2. Contributes to the achievement of the mission, vision, and values of the Organization.
3. Contributes to the effective operations of the Organization by demonstrating dependability in job performance.
4. Demonstrates a commitment to incorporating the core concepts of patient family centered care into practice (dignity, respect, information sharing, and participation).
5. Demonstrates a commitment to the development and implementation of shared governance across the Organization.
6. Performs other related duties as assigned.

WORKING CONDITIONS, HAZARDS AND PHYSICAL EFFORT:

Primarily light work requiring to move or position up to 10 lbs. Long periods in a stationary position and moving around the unit. Works in a well-lighted, ventilated and air conditioned area when in the office; required to go to patient areas and other parts of the Organization for retrieval of information, patient interviews and assessment, meetings and related activities. During home visits possible exposure to disease, infection and physical strain and assault, as well as exposure to blood, body fluids, and tissue. Moderately stressful environment where department's workload must be completed within prescribed time frames using fixed staffing resources.


CONTACTS WITH OTHERS:

Nursing staff, physicians, department managers, ancillary staff, patients, families, review specialist, EHR, other case management workers, community resources/services, and referral agencies.

EQUIPMENT USED/SPECIAL SKILLS REQUIRED:

Proficient computer skills required. Preferred knowledge of the Meditech software or equivalent. Must be skilled in medical terminology and diagnosis. Utilizes communication skills with a high degree of effectiveness in working with physicians, hospital staff, consultants and review agencies.

Minimum of five (5) years' experience in a healthcare setting; ability to access, evaluate and intervene as needed in the care delivered to an assigned population; ability to effect change and be a change facilitator; knowledge of funding resources, services and clinical standards and outcomes; possess effective communication skills, both written and verbal; basic knowledge of growth, development and range of treatment needed by assigned patients.