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Acute Care Nursing Case Manager
2 months ago
Position Overview:
The Acute Care Nursing Case Manager employs established methodologies to achieve optimal patient outcomes while ensuring timely, coordinated, and cost-effective care delivery.
This role encompasses the responsibility, accountability, and authority for overseeing the medical management of hospitalized patients, utilizing outcome-focused strategies.
The Case Manager collaborates with the healthcare team to assess, plan, and facilitate a personalized continuum of care for patients, tailored to their assessed needs and available resources.
The Case Manager continuously evaluates clinical strategies and recommends alternative care levels as necessary. This position requires effective collaboration with patients and interdisciplinary healthcare team members.The Case Manager adopts a proactive stance to ensure the integration of clinical and operational outcomes through the analysis of clinical and financial metrics, including length of stay and diagnosis-related group profiling.
Qualifications, Licensure & Certification:
Educational Background:
A Bachelor of Science in Nursing (BSN) or a Bachelor of Arts (BA) degree in conjunction with a nursing degree is required.
Registered nurses with five (5) years of relevant experience who are committed to pursuing a BSN or BA will be considered.
Obtaining a BSN within two (2) years of hire is mandatory.Consideration may be given to registered nurses with extensive clinical experience who possess a bachelor's degree in a related discipline.
Professional Experience:
A BSN or BA with a minimum of five (5) years of relevant experience demonstrating leadership and autonomy in nursing practice is required.
Ability to utilize critical thinking skills to develop clinical programs or positions and b) Proven leadership capabilities. For exceptions regarding licensure, substantial clinical experience is necessary:
five (5) years of experience in an acute care environment with a strong foundation in care management, utilization review, and payer relations.
A Case Management certification or the intention to obtain such certification within one (1) year of eligibility is highly encouraged.Key Responsibilities:
1) The Acute Care Nursing Case Manager collaborates to ensure that patients receive appropriate care in suitable settings, engaging a wide range of health and community providers.
a) Works closely with the Medical Director and other healthcare team members to facilitate effective medical management and resource utilization based on established criteria.
b) Educates physicians and healthcare team members on the coordination of care processes across the continuum.
c) Participates in an on-call system to guarantee 24-hour accessibility and accountability to meet patient needs.
d) Advocates for patients by representing their best interests to healthcare providers.
e) Secures insurance authorizations as necessary to ensure appropriate and cost-effective care.
f) Acts as an institutional advocate by managing care efficiently and communicating with third-party payers.
2) Coordinates medical management through ongoing interaction with patients, families, physicians, and other healthcare providers to achieve designated clinical, operational, and financial goals.
a) Facilitates clinically appropriate treatment and coordinates service flow by serving as a communication hub for healthcare team members, patients, providers, and payers.
b) Supports the development, integration, and monitoring of clinical pathways and guidelines.
c) Maintains accountability for care coordination processes during the acute care phase and the transition to outpatient services.
d) Initiates and participates in patient care conferences as appropriate.
e) Completes nursing assessment forms and other referral procedures as needed for ongoing care requirements.
f) Provides leadership for clinical staff regarding complex patient care issues and/or patients who do not meet expected outcomes.
3) Identifies individual patient discharge needs in collaboration with clinical team members, beginning with the initial admission assessment and continuing throughout the care episode.
Takes the initiative in working with the interdisciplinary healthcare team and patients/families to identify treatment plans that streamline care, control costs, and enhance patient outcomes.
a) Assists in implementing discharge planning as necessary, through ongoing monitoring and reevaluation to accommodate treatment changes or progress. Anticipates treatment changes and develops contingency plans.b) Ensures patients understand their rights, choices, and potential consequences.
c) Completes referral procedures to appropriate institutional, community, or specialized resources.
4) Integrates patient information, clinical, financial, and operational data to evaluate impacts on patient, clinical, and financial outcomes. Identifies opportunities to maintain or reduce costs and optimize case reimbursement.
a) Identifies cost/clinical outlier patients for intensive case management and facilitates evaluation of alternative care options.
b) Ensures compliance with documentation requirements and guidelines from third-party payers, regulatory, and government agencies.
c) Engages in long-term planning to address the needs of high-risk patients and/or populations.
5) Demonstrates leadership skills, including effective written and verbal communication, conflict resolution, problem-solving, critical thinking, organizational and time management skills, and appropriate delegation.
a) Develops and fosters collaborative relationships with other members of the Guthrie Healthcare System Enterprise and community resources, including home health agencies, durable medical equipment companies, nursing homes, etc., to explore alternative care options for identified patient needs.
b) Maintains a positive and professional relationship with payers to support ongoing managed care contracts.
c) Clearly articulates the primary objectives of Care Coordination processes to all members of the healthcare and leadership teams and others as necessary.
6) Engages in performance improvement and educational activities.
a) Incorporates current evidence-based data into clinical care management.
b) Demonstrates knowledge of federal, state, and system regulations and aligns practice to comply with them.
c) Serves as an educational resource for other healthcare team members regarding changes in reimbursement and/or utilization requirements.
d) Maintains a minimum of 8 hours of continuing education annually.
7) Contributes to Performance Improvement (PI) initiatives through both individual and aggregate data monitoring. Initiates and leads performance improvement activities as appropriate based on outcome data and/or identified issues.
Other Responsibilities: 1. Additional duties may be assigned as necessary for this position.
The compensation for this role is $51.46 per hour.
Being part of the Guthrie team means contributing to a legacy of excellence in healthcare.
At all levels of Guthrie, you will find dedicated staff members committed to serving the community.
The Guthrie Clinic is an Equal Opportunity Employer that embraces and promotes diversity in the workplace.The Guthrie Clinic is a non-profit, integrated, physician-led organization operating in the Twin Tiers of New York and Pennsylvania.
Our multi-specialty group practice comprises over 500 physicians and 302 advanced practice providers, offering 47 specialties through a regional office network that provides primary and specialty care across 22 communities.
Guthrie Medical Education Programs include residencies in General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology, and Orthopedic Surgery, as well as fellowships in Cardiovascular, Gastroenterology, and Pulmonary Critical Care.
Guthrie also serves as a clinical campus for the Geisinger Commonwealth School of Medicine.