RN Case Manager

5 months ago

Omaha, United States Omaha Children's Hospital Full time

Schedule: Mon-Fri, 0730-1600, No weekends or holidays

At Children’s, the region’s only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team—and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview

Serves as a patient advocate, guiding patients through the health system in a timely and cost effective manner while maintaining a high standard of care. Works in partnership with physicians and other disciplines to coordinate care and facilitate a discharge plan of care. Promotes efficient and effective service delivery through enhanced communication and coordination of the patient specific plan of care. Ensures the established standard of care and expected outcomes are achieved in a timely manner while facilitating appropriate resource utilization and enhancing customer satisfaction.

Essential Functions

  • Performs assessment/reassessment based on clinical indicators and anticipated services for appropriate level of hospital care considering safety, quality, and cost. • Meets with the family and health care team to assess for diagnosis, care needs, and discharge plans. • Introduces Nurse Case Management (NCM) role to family. • Completes NCM assessment and documents in progress note. The assessment is reevaluated according to changes in condition, and when transfers to another location occur. • Provides education to the family related to the assessment, available resources, and plan of care. • Incorporates evidence-based practice in conducting the nursing assessment, care coordination, and the discharge process. • Develops plan of care with the family and health care team. • Acts as a resource to the health care team regarding patient-specific plan of care to include discharge needs or alternative levels of care. • Ensures and provides handoffs to internal and external healthcare providers, personnel, and/or community agencies to coordinate services and assist with continuity of care.

  • Maintains up to date information regarding the patient-specific plan of care and current status related to care coordination. • Develops action plan in collaboration with family, physician, healthcare team, and third-party payers, as applicable. • Meets regularly with patient/family, developing a supportive relationship. • Ensures communication with interdisciplinary team and works to remove barriers from accessing appropriate healthcare resources and appropriate level of care • Reassesses needs and provides appropriate interventions. Monitors and evaluates patient status. • Ensures patient-specific plan of care is met based on the input from the family and adjusts goals and interventions as needed. • Communicates plan of care and discharge plan with patient/family, health care team, home care liaison, and community providers. • Identifies primary care physician (PCP); works with parent/caregivers to identify a PCP if not already aligned with a clinical practice/medical home • Negotiates with third party payors regarding appropriate home care needs when necessary. • Utilizes evidence-based guidelines to anticipate length of stay (LOS) and assists in managing avoidable days. • Ensures documentation meets department guidelines, standards, and policies.

  • Works with patient/family to assess needs related to diagnoses, care, and discharge plans, and to help establish expectations of care delivery with family, ensuring that they are actively involved or represented in the plan of care. • Acts as a resource to the healthcare team regarding the patient-specific plan of care. Provides leadership to the care team to accomplish outcomes. • Participates in multidisciplinary care conferences for the patient/family in order to facilitate plan of care progress. • Analyzes variances from the plan and dispatches departmental and educational resources, communicating anticipated timeframes and working across departments to prevent or resolve delays in service. • Coordinates with the healthcare team to identify and implement appropriate discharge plans incorporating opportunities for alternative care when appropriate. • Conducts follow-up calls to patient/caregivers to identify any barriers to accessing healthcare or resources, educational needs, and adherence to plan of care • Coordinates scheduled transfer and transport to alternative levels of care when appropriate, to include authorizations for service and Preadmission Screening and Resident Reviews (PASSRs). • Monitors/evaluates utilization and re-admission data and participates in multidisciplinary councils to address performance improvement and processes.

  • Communicates and collaborates with the Utilization Management (UM) Nurse, or other NCMs as necessary to provide information relating to the plan of care, regulatory requirements, payer issues, and benefits management. • Understands the NCM and UM Nurse role in revenue cycle management. • Collaborates with the UM Nurse to identify and document Avoidable Days according to department processes, as applicable. • Utilizes level of care screening criteria to assist with appropriate level of care assignment and placement, as applicable.

  • Monitors system to report case management outcomes and works as a change agent in the resolution of systems issues. • Identifies opportunities for optimizing care delivery. • Participates in Shared Governance. • Provides educational consults, programs, and presentations internally and externally as needed.

Education Qualifications

  • Bachelor's Degree from an accredited college or university in nursing Required

Experience Qualifications

  • Minimum 5 years in nursing required, preferably in a pediatric setting. Required

Skills and Abilities

  • Demonstrates written and verbal communication skills.

  • Ability to apply the nursing process to acute patient care to achieve outcomes.

  • Current knowledge of the healthcare environment, including community resources and financial systems.

  • Working knowledge of basic computer programs such as Word and eEcel.

  • Previous EPIC experience preferred.

Licenses and Certifications

  • Current and valid Nebraska RN license/RN Compact license Upon Hire Required and

  • Current and valid Basic Life Support (BLS) through the American Heart Association Upon Hire Preferred and

  • Certification from a nationally recognized case management organization Upon Hire Preferred

Children’s is the very best for kids and the very best for your career At Children’s, we put YOU first so together, we can improve the life of every child

Requisition ID : 21191

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