Nurse Case Mgr

Assistant Director of Nursing – Case Management (Non-Union)

The ADON has overall day‑to‑day responsibility for directing, supervising and managing the activities of the Case Management Team. Facilitates the Hospital’s goals of reducing length of stay, improving patient care, efficient and effective utilization of resources to ensure appropriate continuum of care of patients. Functions as resource person and troubleshooter for case management team and discharge planning regarding barriers to discharge.

Conducts daily rounds. Acts as liaison with nursing and medical staff and other clinical departments to integrate the department’s functions and services with other aspects of the patient care process. Schedules case management team members to ensure adequate coverage. Assists the Director with the development of appropriate staffing plans. Responsible for interviewing, hiring, orientating and the disciplinary process of team members.

Assesses, revises and maintains established department policies and procedures, objectives, performance improvement program, safety, environmental and infection control standards in collaboration with Director of Case Management. Negotiates with vendors, providers and home care agencies to optimize services. Collaborates with managed care companies to facilitate appropriate use of benefits and services to patients (e.g., obtains optimum coverage while in hospital; negotiates appropriate nursing home/home care services with company‑approved agencies or arranges for use of alternate agency).

For direct care providers:
Provides age‑appropriate care and intervention for ages of patients served according to job description (e.g., assessments, treatment plans, assists with assessments).

For non‑direct care providers:
Provides support services using age appropriate interpersonal communication.

Coordinates discharges that require services of a certified home health agency.

Negotiates with vendors, providers and home care agencies to optimize services.

Collaborates with managed care companies to facilitate appropriate use of benefits and services to patients (e.g., obtains optimum coverage while in hospital; negotiates appropriate nursing home/home care services with company‑approved agencies or arranges for use of alternate agency).

Functions as clinical resource person for the multidisciplinary health care team, patient and family on insurance benefits, managed care process, clinical and utilization review issues in order to maximize quality of patient care and effectively manage length of care.

Applies appropriate third‑party payor procedures regarding financial coverage, non‑coverage and alternate level care. Explains and distributes notifications to patient and/or family representative.

Completes all forms required for discharge in a timely manner (e.g., Patient Review Instrument).

Reviews all admissions within 24‑48 hours to ensure they are appropriate for acute care and made to the appropriate setting. Identifies potential treatment and discharge problems (e.g., required treatment is not performed at Maimonides Health, patient has no appropriate place to go on discharge). If admission is assessed as inappropriate, consults with responsible physician to clarify plan of care. Completes assessment for patient discharge planning needs within 24 hours.

Acts as a liaison with nursing and medical staff and other clinical departments to integrate the department's functions and services with other aspects of the patient care process.

Consults and collaborates with physicians and other members of the health care team to coordinate plan of care, determine the most cost‑effective use of hospital resources, and remove obstacles for timely, efficient discharge.

Collects and analyzes patient data to advise the health care team on appropriateness of care, patient outcomes and other relevant continuum of care issues.

Key member of Interdisciplinary Team (IDT) rounds. Provides key information to IDT team regarding DRG, GMLOS, confirms projected discharge date, ensures appropriateness of continued stay, updates the team on discharge planning and any obstacles to discharge…