Case Manager RN

Case Management Coordinator

Under general supervision of the Manager, Case Management, coordinates the clinical and financial plan for patient assignments, performs overall utilization management, resource management, discharge planning, care facilitation, and referral to other levels of care and related duties. Works with the physician and interdisciplinary team to achieve desired quality and financial outcomes.

Must demonstrate the knowledge and skills necessary to provide care appropriate to the age, culture, ethnicity, and specific individual diagnostic needs of the patients served in his/her department. He/she must be able to assess and interpret data about the patient's status in order to identify each patient's specific needs and provide the care needed by the patient group (pediatric, adolescents and/or geriatric patient group, culture and diagnostic specific).

Consistently expresses and demonstrates compassion and courtesy for patients. Extends courtesy and support to patient's families/visitors.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by the person assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

• Technical Domain-Documentation: Accurately and concisely records interactions along the continuum from admission to discharge: meets case management documentation standards
• Technical Domain-Documentation: Submits complete and accurate reports of tracking activities within established time-frame and format
• Critical Thinking Domain-Discharge Planning: Demonstrates creative and resourceful critical thinking and problem-solving abilities
• Utilization Review: Assess appropriateness of admission, continued stay, and discharge of patients
• Interpersonal Domain-Customer Service: Represents the organization in a professional manner
• Age-Specific Care: Demonstrates age-appropriate interactions with all patients. Must demonstrate the knowledge and skills necessary to provide care appropriate to the age, culture, ethnicity, and specific individual diagnostic needs of the patients served in his/her department. Must be able to assess and interpret data about the patient's status in order to identify each patient's specific needs and provide the care needed by the patient group (pediatric, adolescents and/or geriatric patient group, culture and diagnostic specific). Consistently expresses and demonstrates compassion and courtesy for patients. Extends courtesy and support to patient's families/visitors.
• Leadership: Coordinates and provides leadership and direction to team conferences
• Leadership: Promotes and participates in team building activities
• Communication: Establishes and maintains an effective means of communicating pertinent information to interdisciplinary team members, manager, patients and families
• Maintain confidentiality in accordance with hospital policy and professional standards.
• Refer identified clinical issues and lapses in standards of care to appropriate areas.
• Identify the need for guardianship appointment and make appropriate referrals
• Maintain hospital and department policies, procedures, and objectives as well as safety, environmental, and infection control standards.
• Ensure patient safety in the performance of job functions and through participation in hospital, and unit/program patient safety initiatives.
• Take action to correct observed risks to patient safety.
• Report adverse events and near misses to appropriate management authority.
• Implement policies, procedure, and standards consistently in the performance of assigned duties.
• Identify possible risks in processes, procedures, devices and communicates the same to those in charge. Remain vigilant to potential problems and take action accordingly.
• Respect for individuals, Customer Service, Teamwork and Collaboration:
• Coordinate and lead Family Conferences and participates in Rounds, Plan of Care Meetings/Team Conferences.
• Collaborate with the interdisciplinary team to facilitate a continuum of care to meet internal and external customer needs. Act as the liaison with the interdisciplinary team, the patient/family/support network and the managed care organization. Foster a well-coordinated care experience for the patient, family and care providers.
• Interpersonal Domain-Customer Service: Model excellence in customer service behaviors in daily practice. Identify and act on opportunities to respond to customer requirements. Take action to prevent potential customer complaints. Foster a well-coordinated care experience for the patient, family, and care providers. Incorporate good customer service skills into daily practice.
• Leadership, Clinical and/or Technical Skills
• Collaborate in the assessment of the patient including appropriate social, emotional and financial resources, discharge needs, and problems identified as barriers to discharge.
• Collaborate with the unit program manager and the interdisciplinary team to develop, implement and evaluate an interdisciplinary plan of care and prioritized goals.
• Involve the patient, family and support network in the process of developing, implementing, and monitoring the plan of care and goals.
• Other duties as assigned.
• Quality and Patient Safety:
• Facilitate the discharge planning process by coordinating a viable discharge plan for the removal of barriers to discharge which meets the patient's individual needs; link the patient with the most appropriate institutional and community resources; advocate on behalf of the patient to ensure a smooth continuum of care.
• Cost Effectiveness:
• Explore strategies to reduce length of stay and resources consumption by sharing observations with the interdisciplinary team, promote the implementation of recommendations to the team, and document all results. Must also provide appropriate interventions and assistance with problem solving each individual case as needed.
• Complete and submit all required written documents accurately and timely (e.g. Denial and Appeal report).
• Provide information to and confer with the managed care representatives to promote attainment of goals, continuity of care, and positive patient outcomes.
• Contribute to the departmental budget process.
• Education and Research:
• Maintain current knowledge/expertise in the area of specialty. Attend and participate in department meetings, in-service training and educational programs for continued professional growth and development

Work Experience

• Current licensure as a Registered Nurse in the State of Maryland is required.
• Bachelor's degree in Nursing, or related field required for new hires effective 9/2019.
• A minimum of three years' experience in clinical nursing in a hospital setting is required.
• Additional experience in home care, transitional care, or insurance arena, preferred
• Certification in Case Management is preferred.

Knowledge, Skills and Abilities

• Experience in utilization management, case management, and/or discharge planning is strongly preferred.
• Excellent problem-solving, team-building, analytical and communication skills are required.
• Knowledge and application of current computer technologies are required.
• Ability to work independently; display flexibility and adaptability is required
• Highly effective verbal communication skills including courtesy, resourcefulness and efficiency in answering questions, giving directions, locating staff and explaining hospital/departmental policies and procedures are necessary. Verbal communication skills may include communicating with an interdisciplinary team, patients, and families.
• Effective writing skills are also required in order to take messages and maintain miscellaneous records, receipts, reports and logs.