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Case Manager RN

1 month ago

Marquand, Missouri, United States Health & Hospital Corporation of Marion County Full time
Job Summary

The Case Manager and Discharge Coordinator RN serves as the overall coordinator of care, collaborating with Social Work, Physicians, Interdisciplinary Team, Nursing, and patients/families to provide seamless and efficient service for the trauma and orthopedic teams. This position is responsible for managing each patient's plan of care, monitoring for appropriate resource utilization, and coordinating the patient's discharge plan.

Key Responsibilities
  • Coordinate care, collaborating with Social Work, Physicians, Interdisciplinary Team, Nursing, and patients/families to provide efficient services for the trauma and orthopedic teams
  • Manage each patient's plan of care, monitoring for appropriate resource utilization, and coordinating the patient's discharge plan
  • Coordinate the patient's care, serving as a patient advocate, delivering efficient healthcare
  • Communicate with Physicians, Physician extenders, Interdisciplinary Team, Nursing, and patients/families to ensure timely patient progression through the episode/plan of care
  • Resolve problems impeding diagnostic or treatment progress and proactively resolve delays to discharge
  • Utilize conflict resolution, critical thinking, and negotiation skills to ensure timely resolution of issues
  • Identify strategies to reduce the length of stay and resource consumption within the targeted population
  • Personally interview patients and other relevant sources to collect information in an attempt to identify individual needs and develop a comprehensive plan of care that addresses medical, social, and financial needs
  • Collaborate with the teams, Transition Support leadership, and Medical Director to identify cases that require special intervention
  • Document avoidable days and quality indicators as appropriate
  • Actively participate in creating/planning an action-oriented and time-specific plan of care
  • Assure adherence to clinical pathways/protocols and the appropriate use of clinical tools through collaboration with Physicians, Interdisciplinary Team, Nursing, and unit staff
  • Continually monitor patients for change in condition warranting initiation of a clinical pathway, alteration in plan of care, or change in care acuity in an attempt to determine the effectiveness of the care plan
  • Evaluate at appropriate intervals that the quality of healthcare to each patient is delivered in an efficient manner throughout the patient's episode of care
  • Educate rotating surgical residents on case management duties and new updates to maintain compliance
  • May conduct or provide oversight of the initial admission review, utilizing InterQual criteria, within hours of the patient's admission to the hospital to ensure appropriateness of the assigned level of care and timely implementation of the treatment plan
  • Apply InterQual criteria to complete concurrent reviews as indicated by payer or ~ every 72 hours
  • Educate Physicians, Interdisciplinary Team, and Nursing regarding payer sources and the role this plays in discharge planning
  • Communicate as necessary with the on-site private payer/managed care Case Managers
  • Coordinate with Social Work regarding Financial Counseling and or Case Enhancement Specialist to assure private payer pre-certification/authorization for services is obtained when required
  • Address private payer denials
  • Evaluate the active funding for each patient and communicate with Financial Counseling to facilitate the initiation of appropriate funding applications
  • Address financial barriers to healthcare/medical compliance with the patients/families when indicated
  • Coordinate discharge planning for assigned patient with Social Work
  • Facilitate discharges to post-acute services such as LTACs, Skilled Nursing Facilities, or Nursing Homes and discharge planning including Home Health Care and durable medical equipment
  • Document relevant Case Management Process and discharge planning information in medical record
Requirements
  • Active RN license in the State of Indiana, or ability to obtain licensure through application
  • Minimum of 5 years of clinical nursing experience
Knowledge, Skills & Abilities
  • Demonstration of Case Management knowledge and managed care processes
  • Competency in: Interpersonal, written/verbal communication, and negotiation skills
  • Diplomacy, flexibility, and professionalism
  • Cohesive networking with the Interdisciplinary Team