Registered Nurse - Case Manager

CASE MANAGER RN NEEDED - 5/8s Every Other Weekend Certification Requirements: CA RN LICENSE BLS

Experience:

5+ Years of RN Case Management experience

JOB DUTIES:

Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through effective resource coordination.

The goals of this role are to include the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self
-determination while coordinating in a timely and integrated fashion. He/She collaborates with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical and social situations efficiently in order to avoid unnecessary admissions.

JOB

ACCOUNTABILITIES :
Patient Initial and Continued Assessment.
• Reviews initial physician admission care plan. Gathers additional medical, psychosocial, and financial information from the patient/family interview, medical record assessment, physicians, and other health care providers. Determines moderate or high risk level for readmission. Conducts a screening for ancillary supportive services, including but not limited to Palliative Care Services' needs.
• Functionally supervises and actively leads the health care team in developing comprehensive cost-effective care coordination plans that meet the clinical needs of our patients.
• Identifies and refers quality and risk management concerns to appropriate level for patient safety reporting and trending.
• Directs and oversees the Case Management Assistants to determine preferences for post-acute care services. Utilization Management.
• Reviews medical record to ensure patient continues to meet level of care (LOC) requirements and that chart documentation supports LOC determination and assignment.
• Works with Attending Physicians to confirm necessary documentation to support level of care (LOC).
• Expedites transition planning for patients who no longer require acute level of care.
• Monitors length of stay (LOS) and outliers requiring additional resources and/or focus.
• Collaborates with financial counselor for delivery of inpatient stay denials.
• Assures delivery of Medicare Important Message within 48 hours of discharge/transition and no less than 4 hours of actual discharge/transition.
• Actively participates in patient rounds following the standard work as developed and collaborates with interdisciplinary team to assure timely transition.
• Follows policies and procedures for Physician Advisor referrals.
• Utilizes appropriate escalation process when discussing level of care (LOC) requirements with providers.
• Consistently documents in the EHR and other electronic software.
• Maintains current knowledge of CMS and Joint Commission Transitions of Care requirements, Conditions of Participation (COPs), and other regulatory requirements.
• Effectively follows Observation patients, re-evaluates and collaborates with attending physician for admission or transition to appropriate level of care for the patient. Care Coordination/ Care Transitions.
• Formulates a transition plan after reviewing available/appropriate care options and obtaining input, and collaborating with the patient/family and physician, health care team, payers, and community based support services.
• Performs, documents, and communicates assessment findings to health care team.
• Screens 30-day readmissions; reviews previous hospital record confers patient/family and with interdisciplinary team to create an effective and realistic transition plan.
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