SAH RN Case Manager

SAH RN Case Manager – Brown University Health

Join to apply for the SAH RN Case Manager role at Brown University Health

Strategic role promoting high quality patient care balanced with patient/hospital advocacy. Brown University Health employees expected to role model Compassion, Accountability, Respect, and Excellence. Core Success Factors:
Instill Trust and Value Differences, Patient and Community Focus, and Collaborate.

KEY RESPONSIBILITIES:

Coordinates patient care across the continuum of care:
As needed, strives to maximize and mobilize all internal and external resources that facilitate the case management process for all assigned cases Documentation always reflects patient plan of past hospital care and if applicable interdisciplinary coordination As needed, provides a nursing assessment within 24‑48 hours of patient admission for clinically oriented services focused on mobilizing primary care physician, hospital systems, patient/family and community resources directed towards facilitating a clinically safe and timely discharge Identifies problems and gaps in patient care when covering for unit case manager.

Suggested interventions, expedited interdisciplinary referrals and ensured diagnostic testing is completed and reported within appropriate timeframe Actively participates in patient care conferences as scheduled on nursing units when covering for the unit case manager Works collaboratively with medical staff, nursing and other therapeutic disciplines in developing and implementing a patient plan of care while covering for case manager. Follows plan of care initiated by unit case manager.

Initiates initial plan of care for new patients assigned. Clinically documents patient plan of care, progress, goals, and interventions according to Case Management Department, Federal, and State guidelines. Maintains a professional working relationship with Managed Care Organization telephonic and on site reviewers and external reviewing agencies in monitoring course of hospitalization and need for post hospital services according to third party payor guidelines.

Returns all calls from managed care organizations occurring on day covering the case. Community health care agencies and third party payor utilization review agencies are provided with patient care information through allscripts that is concise, accurate and communicated in a timely manner. All reviews assigned to per diem case manager sent when completed unless review referred for second level review.

Monitors utilization of resources:
Exercises professional authority intervening when necessary with physicians /therapeutic disciplines to remove barriers that impact length of stay. Communicates via allscripts to unit case manager any issues identified while covering unit Always demonstrates awareness of over or under utilization of resources and responds accordingly Appropriately monitors utilization of resources for caseload assigned Demonstrates understanding and has accurately applied severity of illnessintensity of service criteria according to third party payor guidelines, appropriately identifying levels of care for all assigned cases.

Maintains ongoing dialogue with medical staff, nursing and other involved therapeutic disciplines relative to utilization and length of stay issues and communicates via Allscripts to unit case manager Demonstrates initiative in exploring strategies to reduce length of stay and resource consumption within complex case managed patient populations. Effectively identifies patients for complex management versus those patients with less significant needs care Communicates with other members of healthcare team regarding patients’ needs, plan and response to As needed, offers assistance/solutions to physicians in resolving external third party payor issues Negotiates, procures, and coordinates service and resource:
Based on third party payor criteria, always works with patients/families/physicians to effect a positive length of stay outcome Always demonstrates critical thinking and sound clinical judgment in matters of patient advocacy versus conflict with the third party payor…