Case Manager, RN

Case Manager, RN – AHMC Health Care

Apply for the Case Manager, RN role at AHMC Health Care
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Under the general supervision of the case management director, the Case Manager acts as a patient advocate and coordinates, negotiates, procures services and resources, and manages the care of complex patients to facilitate the achievement of quality and cost‑efficient patient outcomes. This autonomous role looks for opportunities to reduce costs while ensuring the highest quality of care is maintained. The Case Manager applies review criteria to determine medical necessity for admission and continued stay, provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost‑effective quality health‑care, and assists in identifying appropriate utilization of resources across the continuum of care.

The role works collaboratively with interdisciplinary staff both internal and external to the organization and participates in quality improvement and evaluation processes related to patient care management.

• Initial screening of all elective inpatient admissions related to:
  • Level of care
  • Appropriateness of admission (IS‑SI)
  • Discharge needs
  • Third‑party contractual arrangements
  • Appropriate resource utilization
  • Pre‑admission screening and education of identified patient populations
  • Out‑of‑area transfers
  • Documentation of patients admitted directly through Pre‑Admissions in the laptop system and forwarding information to Case Managers with discharge‑planning concerns and the initial discharge‑planning screen

• Develops educational programs (pre/post‑op surgeries), high‑risk screening tools, Care‑Maps for the Pre‑Admit phase of identified populations, and proactive discharge planning.
• Coordinates OOA/OON Managed Care admissions, meeting criteria and the level of care appropriate according to Inter Qual and Millman & Robertson Guidelines.
• Serves as a source in selecting and assigning admission types (e.g., In Patients, 2359, SOS, etc.).
• Interacts with the admitting MD as appropriate, involving the Physician Adviser as needed for inappropriate admits/transfers/level of care.
• Oversees that Pre‑Admit TARs are obtained and patient payer sources have the appropriate network among the patient’s health‑care team (Case Mgmt, Business Office, Physicians, Social Services, Nurse Manager, etc.).
• Is a clinical resource to the admitting department and provides ongoing education on the effective resources of the Pre Admission Case Manager and Quality/Case Management Department to physicians, physician office staff, nursing.
• Maintains identified tracking and data statistics as requested by Commitment to Quality role in Case Management.

• Aware of and follows all hospital and department process policies and procedures.
• Knowledgeable of Improvement performance/process improvement (P.I.) methodology.
• Can verbalize knowledge of hospital‑wide performance/process improvement activity.
• Offers suggestions for departmental and/or hospital‑wide performance/process improvement.
• Knowledge of and participation in the performance/process improvement is a condition of employment.

• All interactions conducted in a professional manner.
• Verbal and written feedback from patients, family members/significant others, medical staff, visitors and co‑workers indicates behavior conducive to positive guest relations.
• Consistently exhibits appropriate phone protocol (e.g., answers phones promptly, is courteous, helpful and identifies self and department).
• Consistently contributes to the team effort (e.g., assists co‑workers when need is observed or upon request, offers constructive suggestions rather than complaints).
• Consistently displays cheerful and positive attitude.

• Maintains high productivity and performs efficiently regardless of work volume.
• Appropriately prioritizes work activities.
• Responds to difficult situations with self‑control and a positive attitude.
• Makes decisions independently and knows when to ask for assistance.
• Exercises good judgment and arrives at sound decisions.

• Reports to work each…