Description
Description
Job Summary
The Case Manager, RN provides comprehensive care coordination of services as a member of the interdisciplinary care team and provides discharge planning for a designated patient population. Consistently exercises discretion and judgment to assess, analyze, interpret and implement interventions to facilitate transitions of care. Position will assess, coordinate, facilitate and negotiate services and resources for a designated patient population in order to achieve desired clinical and financial outcomes as directed by Excela Health Systems. Works in collaboration with the patient's healthcare team to move the patient through the continuum of care.
Essential Job Functions
Maintains professional and technical knowledge by attending education workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Assures quality of care by adhering to therapeutic standards; measuring health outcomes against patient care goals and standards; making or recommending necessary adjustments; following system/hospital and nursing division's philosophies and standards of care set by state board of nursing, state nurse practice act, and other governing agency regulations.
Protects patients and employees by adhering to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.
Documents patient care services by charting in patient and department records.
Maintains continuity among nursing teams by documenting and communicating actions, irregularities, and continuing needs using Nurse Knowledge Exchange techniques.
Maintains patient confidence and protects operations by keeping information confidential.
Implements standard work, clinical protocols and patient care pathways.
Ensures safe and effective transitions of care that help to promote positive health care outcomes for Excela Health patients.
Assesses, plans, implements coordinates, and monitors and evaluates options for patients, their families, caregivers and the health care team, including providers, to promote effective care coordination outcomes.
Manages transitions of care effectively as one of the critical components to reducing readmissions and poor health outcomes. Provides crisis management for clients; makes linkages for interventions as appropriate.
Initiates care coordination strategies that are evidence-based and outcome focused.
Implements standard work, clinical protocols and patient care pathways.
Identifies patient care requirements by establishing personal rapport with potential and actual patients, and other persons in a position to understand care requirements.
Establishes a compassionate environment by providing emotional, psychological, and spiritual support to patients, friends, and families.
Promotes patient's independence by establishing patient care goals; teaching patient/family to understand condition, medications, and self-care skills; answering questions.
Maintains safe and clean working environment by complying with procedures, rules and regulations; calling for assistance from health care support personnel.
Demonstrates competencies of clinical reasoning and critical-thinking skills for managing complex and high-risk patients while simultaneously assuming the patient advocate role to ensure conflict-free, unbiased and culturally competent care.
Assures care coordination that takes into account patients' values, needs, preferences and their choice to self-direct care.
Puts the patient at the center of all care decisions and is an essential driver to ensuring that patients get the right care, in the right setting, at the right time.
Effectively manages transitions involving comprehensive planning, targeted outreach and the timely transfer of information between parties critical to the transition. Manages transitions of care effectively as one of the critical components to reducing re-admissions and poor health outcomes.
Facilitates the flow of care to expedite appropriate discharge and prevent readmissions.
Assumes the leadership role in achieving outcomes and making the health system work for the patient.
Brings access, understanding and knowledge of the community and the resources to support management of chronic illness.
Resolves patient problems and needs by utilizing multidisciplinary team strategies.
Maintains a cooperative relationship among health care teams by communicating information; responding to requests; building rapport; participating in team continuous quality improvement and problem-solving methods.
Contributes to team effort by accomplishing related results as needed.
Implements effective care coordination strategies that are evidence-based and outcome focused.
Ensures operation of equipment by completing preventive maintenance requirements; following manufacturer's instructions; troubleshooting malfunctions; calling for repairs; maintaining equipment inventories; evaluating new equipment and techniques.
Other duties as assigned.
Specialty Essential Functions
Discharge Planning
Assesses, plans, implements, coordinates, monitors and evaluates options for patients, their families, caregivers, and the health care team, including providers, to promote effective care coordination outcomes.
Coordinates alternate levels of care based on the patient's current needs and availability of healthcare resources.
Creatively resolves complicated disposition issues, utilizing community resources with the integration of the patient's available benefits to achieve a positive outcome.
Provides information for appropriate referrals to patients and their families, and provides counseling, if needed, on a limited basis.
Maintains patient rights by adhering to HIPAA, Freedom of Choice, Rights of Reconsideration, QIO, and other regulatory agency requirements.
Facilitates the flow of care to expedite appropriate discharge and prevent readmission.
Involves patients and families in goal setting and evaluation health care system.
Ensures safe and effective transitions of care across settings for patients.
Case Manager works in collaboration with the Denial Management Specialist:
Facilitates appeals/grievances for concurrent and retrospective appeals.
Assists with maintaining databases that reflect the appeal/grievance component of the utilization process.
Consults with Denial Management Specialist, department Manager and Physician Advisor or designee to resolve issues regarding adverse determinations and denials.
Assists the Denial Management Specialist in de
Compensation Information:
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Starting At: 0.0
Up To: 0.0
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