Case Management Special Programs - Per Diem Case Manager

Summary

The Case Management Special Programs - Case Manager reports to the Manager of Case Management Care Navigation or Director of Case Management. Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management, and the Clinical Manager(s) of respective services across the Brown University Health system. The Case Management Special Programs - Case Manager reviews patients for potential post-acute needs, conducts interview prior to their scheduled surgery, and assists with coordination of care at the various hospitals throughout Brown University Health.

Collaborates with the clinical healthcare team across the patient care continuum to include pre-operative service coordination and post hospital discharge follow-up. Participates in the oversight of the progress of a specific patient population. Collects data and facilitates clinical quality improvement (CQI) teams to enhance the quality and cost effectiveness of patient care and prevent readmissions.

Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these guide our everyday actions with patients, customers and one another.

• The Surgical Services Case Manager will work collaboratively with the surgical teams and case management to provide continuity in patient care and improved patient outcomes.
• Collaborates with Surgeons’ offices to determine patient needs and home safety.
• Completes initial patient assessment prior to patients’ scheduled procedures.
• Partners with medical staff and other members of the healthcare team in collaboration with the patient/family to facilitate the plan of care for a defined patient population across the continuum of care, including post hospitalization.
• Proactively builds post-hospital referrals and coordinates post-acute services prior to surgery.
• Delivers Important Message follow-up notices to all Medicare patients according to Centers to Medicare & Medicaid Services (CMS) regulations.
• Collaborates with members of the patient’s healthcare team to evaluate and facilitate development and implementation of the discharge planning process. Develops the initial patient discharge plan and reviews with patient, family members and other members of the interdisciplinary team as appropriate.
• Provides care plan direction for the advancement of a patient care delivery system which supports managed care strategies and decreases readmission risk. Acts as a change agent by identifying opportunities to improve patient flow and reduce service delays through problem resolution and follow-up.
• Promotes patient satisfaction by facilitating patient participation in education programs and post discharge services as necessary.
• Individual Case Managers may be cross-trained to various programs within the Case Management Special Programs Department including Surgical Services Case Manager, Transfer and Access Case Manager, and Outpatient High Risk Case Manager.
• Performs other duties as assigned.

Licensure as Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nursing or licensure as a Registered Nurse in accordance with the Nurse Licensure Compact agreement of the National Council of State Boards of Nursing.

Bachelor's Degree in Nursing from an accredited National League of Nursing (NLN) program with current license to practice as a Registered Nurse in the State of Rhode Island is required.

Certification by a recognized national organization in case management is preferred.

• Three to five years of clinical/case management experience, preferably in the acute and/or community setting with an emphasis on populations to be served and in utilization management.
• Demonstrated knowledge and skills necessary to provide patient care and to develop or administer care management services with consideration of stages of human development and cultural patterns.
• Analytical skills necessary to evaluate patients, programs, and procedures.
• Demonstrated ability to exercise independent judgement. Refers specific complex problems to Manager of Case Management or designee,…