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Nurse Case Manager

2 months ago

Dubuque, United States Trinity Health Full time

Employment Type:

Part time

Shift:

Description:

POSITION PURPOSE

The Case Manager coordinates care across an episode and/or the continuum for clients with complex problems and diverse needs. The Case Manager’s focus is to maintain patients at an optimal level of health and to support self-care. Case Managers collaborate with physicians, social services, nurses, and community agencies to define care options and resources, to plan cost effective quality care and to achieve optimal outcomes.

Specific responsibilities include case screening, insurance approval, assurance of timely services, and facilitation of discharge with transition to the appropriate services. Patient outcomes are achieved through effective application of care plans, managed care concepts, appropriateness criteria, resource management, knowledge of community resources, and collaboration with other clinical disciplines. Works proactively to coordinate the services of physicians, nurses, and other disciplines to effectively prepare patients for discharge. The Case Manager facilitates program development, efficient care delivery processes and quality improvement including tracking of resource utilization and outcome measures. The Case Manager is accountable for improving service through the use of cost and quality outcome data, current clinical practices and related research, regulatory requirements and comparative benchmark opportunities.

Customers include patients, families/visitors, physicians, physician assistants, nurse practitioners, case managers, representatives of third party payers, representatives of referring agencies, interdepartmental and intradepartmental staff, vendors, and volunteers.

ESSENTIAL FUNCTIONS

Actively knows, understands, incorporates, and demonstrates the organization’s mission and core values, including the Guiding Behaviors and Caring Model Principles, and conducts oneself at all times in a manner consistent with these values.

Maintains a working knowledge of applicable Federal, State and local laws and regulations, Trinity Health’s

Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

Demonstrates knowledge, skills and abilities to provide case management services appropriate to the age of patients served.

Exhibits sound judgment, critical thinking, problem solving and decision making skills.

Communicates effectively with patients, significant others, and members of the health care team.

Compiles information; keeps records, prepares or directs preparation of reports and correspondence.

Executes daily utilization functions for assigned patients, including prior authorization, admission, precertification/certification/recertification, concurrent and retrospective review, associated analysis, and referral appropriateness.

Participates in comprehensive team meetings and conferences regarding specific patient needs that affect cost, quality, and length of stay. Demonstrates ability to promote collaboration and creativity among members of the health care team.

Responsible for assuring thorough case management assessment, as well as early and ongoing discharge plans by collaborating with patients, families, physician, payors, and providers across the continuum of care.

Reports potential catastrophic and high cost cases to department director, nursing director, and finance department for appropriate medical/administrative review and management.

Effectively manages length of stay and cost avoidance.

Discuss cases with Utilization Review Committee and/or Executive Health Resources (EHR) when cases fail to meet admission, treatment, and length of stay and/or discharge standards.

Attends meetings of the Utilization Review Committee and submits reports as required. Participates in the development of a written plan that describes the Utilization Review Program.

Applies quality improvement methods and techniques to improve case management processes to maximize cost and quality benefits for MercyOne Medical Center.

Performs other duties consistent with the purpose of the job as directed.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MISSION STATEMENT AND CORE VALUES

Mission Statement: We, MercyOne Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

  • Reverence: We honor the sacredness and dignity of every person.

  • Commitment to Those who are Poor: We stand with and serve those who are poor, especially those most vulnerable.

  • Safety : We embrace a culture that prevents harm and nurtures a healing, safe environment for all.

  • Justice: We foster right relationships to promote the common good, including sustainability of Earth.

  • Stewardship: We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.

  • Integrity: We are faithful to those we say we are.

MINIMUM QUALIFICATIONS

Must be a registered nurse and must hold an active license to practice nursing in the state of Iowa.

Knowledge of clinical practice and case management processes normally acquired by completing a Bachelor’s Degree in Nursing.

Training and/or Certification in the area of case management is preferred.

Must meet all mandatory education and training requirements within specified timeframes as required by organizational/regulatory standards.

Three to five years’ clinical experience required.

Clinical competency in the case management of rehab population desirable.

Broad-based health care operational experience preferred.

Computer Proficiency: Demonstrated experience and competency with Microsoft Office Suite, e-mail and a variety of web-based programs and browsers, with the willingness and ability to update and increase skills as needed to meet the goals of the departments. Demonstrates specific knowledge related to software programs such as Cerner/PowerChart, HealthQuest, UDS, and other appropriate software programs used in the course of case management processes. Ability to use other software as required to perform the essential functions of the job.

Maintains a professional, collaborative work environment so as to foster a positive public image for MercyOne Medical Center.

Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information (i.e. HIPAA, Stark, etc.)

Demonstrates the ability to work independently, and the ability to work collaboratively in a team environment.

Provides a high level of customer responsiveness and serves as a role model to encourage a commitment to customer service. A strong service orientation is required.

Maintains an excellent working relationship within the department and with all of our internal and external customers.

Ability to handle interactions with discretion, tact and courtesy when dealing with sensitive issues and confidential information.

Must have well developed communication skills; strong interpersonal and collaborative skills with physicians and other healthcare professionals; strong decision making skills that support patient care needs and ethical standards; and the ability to organize work and set appropriate priorities.

Must have excellent written and verbal communication skills with the ability to relate to people across all levels and diverse backgrounds.

Ensures that services are provided in a manner that supports continuous quality improvement and customer-oriented focus.

Keeps supervisor informed about important issues.

Requires professionalism in both dress and conduct on the job.

Demonstrates an understanding of organizational dynamics and administrative procedures and protocols. Ability to function in a dynamic, fast-paced team environment and to cope with ambiguity, time constraints, and other daily stressors in an effective and appropriate manner.

Demonstrates time management, prioritization and organizational skills including an ability and willingness to plan, organize and accomplish tasks accurately and in a timely manner to exercise sound judgment under pressure and to manage multiple and competing activities simultaneously.

Must be able to work independently and productively in a fast paced setting involving multi-task functions and projects. Ability to plan, organize and perform duties with minimal supervision and with a high degree of accuracy and attention to detail.

Proven ability to identify, compile and present data effectively from many different sources for management decision-making.

Must possess advanced analytical skills.

Ability to demonstrate initiative.

Assigned hours within your shift, starting time, or days of work are subject to change based on the changing needs of the department and/or the organization.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

During an 8-hour day, an employee must be able to stand/walk for 6 hours and sit 2 hours.

Job requires occasional (6-10% of work time) squatting, crawling, crouching, kneeling, and balancing; frequent (21%-50% of work time) bending, stooping, reaching above shoulder level, pushing and pulling.

Job requires the ability to frequently (21%-50% of work time) lift and carry objects weighing approximately 11-24 pounds.

Job requires exposure to marked changes in temperature and humidity and may be exposed to infectious disease, hazardous waste and chemicals.

Must have fine motor and manual dexterity skills to grip and manipulate items and perform repetitive action such as computer entry.

Must be able to see at a near visual acuity level; able to speak and hear speech.

Job requires high level of mental concentration to attain established deadlines. Working environments includes frequent interruptions.

Must adhere to applicable organizational requirements on an annual basis for Employee Health Directives.

Must possess the ability to comply with Trinity Health policies and procedures.

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran