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RN Case Manager
3 months ago
Nuvance Health has a network of convenient hospital and outpatient locations - Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York - plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care.
Summary:
The Clinical Care Coordinator - ED acts as principal liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and Health Information Management to ensure appropriate level of care is assigned, progression of care is efficient, and discharge/transition plans are executed as needed.
Provides point of entry care coordination appropriate to the medical necessity determinations and, when necessary, community resources and/or transition plans available.
Assists in transfer process for patients coming in from other hospitals.Responsibilities:
- Manages the Utilization Review elements of the ED encounter for all patients for whom hospitalization is being considered to assure the correct level of care and the optimal initial care plan.
- Makes recommendations for Bed Request orders through thorough review of available clinical information and use of evidence based screening criteria.
- Refers cases appropriately to Physician Advisor review.
- Collaborates with SW Care Coordinators to assure optimal plans of care for discharge.
- Analyzes clinical, financial and social situations, while identifying problems and establishing alternative courses of action.
- Performs rounding with members of the ED team to assure appropriate case identification and planning discussions.
- Advises/educates patients and families on guidelines pertaining to hospitalization and of options for discharge planning.
- Issues all required regulatory notices (Condition 44, HINN ,ABN) as appropriate.
- Offers suggestions and new ideas for improving performance and operations.
- Guides, directs, and educates the health care team to assure optimal outcomes.
- Monitors ED through put and assists in facilitation of testing and procedures.
- Participates in all community teams for management of complex and high recidivist patients.
Assures transmission of information through:
Provision of accurate referrals for discharge/transition planning to community providers through the electronic referral system. Accurate hand off of pertinent information to Care Coordination colleagues.
- Collaborates with UR Specialist to complete the process for transfers in to the hospital.
- Assists with audits and supplies data for various metric analysis.
- Complies with all pertinent standards, regulations and guidelines.
- Fulfills all compliance responsibilities related to the position.
- Performs other duties as assigned.
Other information:
Required:
This position requires a minimum formal education of Associate Degree in Nursing and minimum of three years job-related experience.
Registered Nurse license State of CT with minimum of one year as an acute Care Coordinator. Associates Degree in Nursing. Knowledge and expertise with use of electronic medical record and experience with both Interqual and Milliman screening criteria.Excellent collaborator and team member who is able to work closely with physicians and all members of the health care team to procure the right level of care, correct order for hospitalization, optimal plan of care , and facilitation of services to enhance ED throughput.
Knowledge and expertise in CMS and insurance industry standards as well as guidelines pertaining to appropriate coverage notifications. Ability to be flexible, resourceful and creative in problem solving.Excellent communication skills both oral and written Minimum Experience:
three years Desired:
Certification in Case Management preferred or willing to obtain. Bachelors Degree in Nursing preferred
Location:
Norwalk-34 Maple St
Work Type:
Full-Time
Standard Hours: 40.00
FTE:
Work Schedule:
Day 8
Work Shift:
the shift is days
Org Unit: 374
Department:
Care Coordination-NH
Exempt:
Yes
Grade:
S12
Salary Range:
$ $ Hourly
Credentials:
Essential:
- Registered Nurse
Education:
Essential:
- Associate's Level Degree
Working conditions:
Essential:
- Some manual skills / motor coord & finger dexterity
- Little or no potential for occupational risk
- Medium to Heavy effort. May exert up to 35 lbs. force
- Generally pleasant working conditions.
We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business.
