Registered Nurse; RN - Case Management

Registered Nurse (RN) Case Manager – The Woodlands, Texas

Specialty:
Case Management

Discipline: RN

Duration:
Ongoing

36 hours per week, 12 hour shifts (days, nights)

Employment Type:

Staff

The purpose of the Case Manager position is to support the physician, primary medical homes, and interdisciplinary teams. Facilitates patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions.

In addition, the Case Manager helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The position is responsible for coordinating a wide range of self management support and provides information to update and maintain relevant disease registry activity. Accountable for a designated patient caseload and plans effectively in order to meet patient needs across the continuum, provide family support, manage the length of stay, and promote efficient utilization of resources.

• Coordinates/facilitates patient care progression throughout the continuum.
• Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.
• Addresses/resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies and resolves delays and obstacles to discharge.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load.
• Monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
• Facilitates the following on a timely basis:
  Completes and reports diagnostic testing, completes treatment plan and discharge plan, modifies plan of care as necessary to meet the ongoing needs of the patient, communicates to third party payors and other relevant information to the care team.
• Assigns appropriate levels of care.
• Completes all required documentation in TQ screens and patient records.
• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
• Completes Utilization Management and Quality Screening for assigned patients.
• Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards.
• Identifies at-risk populations using approved screening tools and follows established reporting procedures.
• Monitors LOS and ancillary resource use on an ongoing basis, taking actions to achieve continuous improvement.
• Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.
• Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients.
• Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.
• Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
• Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
• Manages all aspects of discharge planning for assigned patients.
• Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician.
• Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation.
• Ensures/maintains plan consensus from patient/family, physician and payor.
• Refers appropriate cases for social work intervention based on Department criteria.
• Collaborates/communicates with external case managers.
• Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.
• Documents relevant discharge planning information in the medical record according to Department standards.
• Facilitates transfer to other facilities as appropriate.
• Actively participates in clinical performance improvement activities.
• Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource…