RN-Case Mgr

Overview

POSITION SUMMARY: Under the direction of the Case Manager director or other supervisor, assumes the responsibility and accountability for developing, evaluating and directing the plan of care for assigned patients. Works in collaboration with all other care disciplines to provide safe, efficient, and coordinated care for assigned patients. Responsible for facilitating appropriate health care services throughout the continuum of care. Uses collaborative and systematic processes to assess, plan and coordinate the implementation of services that meet the individuals health needs.

• Reports any suspected abuse to the appropriate agencies
• Displays professionalism while completing multiple tasks in a timely manner.
• Records all case management information concisely, accurately and completely, in a timely manner, in EMR and on the appropriate forms.
• Functions as a preceptor or an educational resource in the initial and on-going orientation of new personnel, students, etc.
• Respects and honors cultural and religious differences between patients and self.
• Upholds HIPAA regulations
• Is punctual and can be relied upon to report when assigned to work.
• Maintains professional and technical knowledge by completing Life Talent assignments by established deadlines, maintaining certification and license requirements to insure no lapse in expiration
• Puts patient first. Always. Strives daily to give all customers excellent care.
• Involves the patient and/or family in the utilization of processes which respect patient’s rights.
• Participates in meetings, committees and continuing education to improve both individual departmental and organizational performance.
• Handles conflicts and concerns in a timely and professional manner, utilizing crisis-de-escalation skills when appropriate
• Promotes cooperative relationships among health care teams by communicating information, responding to requests, building rapport, participating in team problem-solving methods.
• Contributes to the maintenance of a safe working environment and the employee’s own personal safety
• Recognizes safety hazards and takes action to maintain a safe environment for patients, staff, visitors and community
• Adheres to Life Safety Codes, MSDS, Infection Control, and all other regulatory and hospital policies
• Participates in performance improvement processes and projects
• Performs job duties in a manner that supports WCCH’s core values & Code of Conduct, and in support of the mission of the organization
• Utilization Management/Utilization Review - Reviews each case to ensure that the patient is receiving the appropriate resources at the appropriate level of care in accordance to standards of care and practice. Applies knowledge of payer rules and regulations to ensure maximum use of benefits while minimizing the patient's financial responsibilities.
• Clinical Care Planning, Implementation and Documentation - Reviews clinical documentation that accurately reflects patients care and severity of illness. Identifies patients that are in need of care coordination and discharge planning.
• Discharge planning - Review screening and referral processes to ensure implementation of discharge plan based on patients identified needs and available resources. Assist with long-term care and placement planning.
• Resource Management - Review and analyze processes designed to ensure appropriate utilization of medication, blood products, operative and invasive procedures, and use of resource intensive diagnostic testing and treatments.
• Outcome Management - Review and analyze clinical, financial and satisfaction indicators. Incorporate Best Practice Standards of Care and regulatory guidelines to assist with the development and the initiation of processes to improve patient satisfaction, documentation, resource management, outcomes, and financial reimbursement.
• Performs prospective admission and concurrent review according to standard policies and procedures. Uses Interqual Criteria or other approved guidelines in determining the appropriate level of care.
• Refers cases to the Physician Advisor according to department policy.

• Current licensure in the Commonwealth of Virginia as a Registered Nurse, and in good standing with the Board
• Bachelors of Science in Nursing preferred.
• Successful completion of an orientation program.
• Knowledge of utilization management and reimbursement mechanisms preferred.
• Knowledge of state and federal guidelines.
• Demonstrates effective written and verbal communication skills.
• Proficiency with PC word process improvement including data collection, analysis and reporting.
• Demonstrates the ability to organize and prioritize.
• Demonstrates knowledge of coding guidelines.
• Possess thorough understanding of Protected Health Information (PHI) associated with the Health Insurance Portability and Accountability Act (HIPAA).