RN CASE Manager: University Hospital; Care Management

RN CASE MANAGER:
University Hospital (Care Management)

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

The RN Case Manager assesses, develops, implements, coordinates and monitors a comprehensive plan of care for each patient/family in collaboration with the physician, social worker and all members of the interdisciplinary team in the inpatient and emergency department patient care areas. The position is unique in that it combines clinical/quality considerations with regulatory/financial/utilization review demands.
The position creates a balance between individual clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes.
Organizational Relationships
The RN Case Manager reports directly to the Manager of Care Management.
The RN Case Manager works closely with the unit-based MPLAN team in reaching unit and organization goals including length of stay, care transitions, readmissions, and other quality initiatives. In the emergency departments, the RN Case Manager works collaboratively with other members of the interdisciplinary team to develop and implement a comprehensive, integrated discharge plan from the emergency department(ED). The RN Case Manager will recommend and document patient classification of all admissions utilizing established criterion set.

Characteristic Duties and Responsibilities

Care Coordination and Discharge Planning

• Within 24 hours of admission interview each patient/family for anticipated needs post hospitalization
• Develop plan for the day and plan for the stay with providers, patient and nursing staff
• Lead daily care coordination rounds to update the plan and facilitate implementation.
• Initiate discharge plan including early referrals to homecare, DME and infusion services
• Prepare patient/family for discharge
• In collaboration with SW partner follow standard for routine patient/family conference
• Ensure patient handovers to next level of care; work closely with Care Navigators in clinics, complex care Case Managers , homecare and sub-acute liaisons
• Support nursing Model of Care by working closely with nursing managers and staff to achieve Patient Family Centered Care goals: respect and dignity, information sharing, participation and collaboration
• Facilitate increased volume of cases discharged by noon to improve capacity management
• Collect avoidable days information; report findings in care management software, such as Allscripts
• Participate in venues to reduce barriers to discharge

Utilization Review and Utilization Management

• Conduct clinical review on admission; review every 3 days or as requested by payer
• Determine patient classification with provider and ensure all patients placed in observation classification are notified;
  For inpatient to observation cases, ensure Condition Code 44 billing requirements are met
• Communicates with third party payers to obtain necessary authorization for reimbursement of services.
• Obtain anticipated LOS from provider and ensure patient and multi-disciplinary team is aware
• Refer defined cases for medical secondary review and share findings with providers
• Provide advice to Revenue Cycle/HIM regarding RAC decision to appeal, denials; input into appeals; share findings with providers
• Review all cases with readmission within 30 days; report findings in Care Management software such as Allscript
• Ide…