Inpatient Nurse Case Manager
3 days ago
Albany Medical Center seeks a skilled Inpatient Nurse Case Manager to join our team. As a key member of our Care Management/Social Work department, you will play a vital role in facilitating the interdisciplinary team to plan, coordinate, implement, and evaluate patient care for assigned service lines across the continuum of care.
Key Responsibilities- Assist the admission MD and designated physician in ensuring coordination of care across the continuum of care in the hospital pre-Nurse Case Manager and post-op.
- Proactively monitor patients' clinical processes through patient care standards and evidence-based guidelines to ensure timely, appropriate interventions that achieve optimal patient outcomes within appropriate LOS and financial constraints.
- Collaborate with the primary nurse in assessing for discharge planning needs, coordinating appropriate resources, and evaluating the effectiveness of the discharge plan.
- Collaborate with the healthcare team and appropriate departments in the management of care across the continuum of care, including pre-admission, discharge, post-discharge, planning length of stay, and utilization of resources.
- Utilize your special body of knowledge and evidence-based guidelines to provide leadership and guidance to the healthcare team in formulating an individualized multidisciplinary plan of care to include pre-hospitalization, acute hospital care, discharge education, transition to home, and use of community resources.
- Facilitate and participate in healthcare team care conferences for patients with complex problems. Facilitate patient and family education and the discharge process to promote continuity of care and optimal patient outcomes.
- Demonstrate experience in the referral process and use of community resources.
- Review data from admission screening to clarify admission diagnosis, establish appropriate length of stay, and identify any potential outliers and determine appropriateness of admission based on institutional standards and evidence-based guidelines.
- Contact payer sources to confirm/negotiate benefits and provide concurrent reviews.
- Identify capitated patients to determine appropriate utilization of services and coordinate post-hospital care using defined standards.
- Identify high-risk patients based on clinical and financial criteria for collaboration with patient financial services to problem-solve available resources.
- Ensure that appropriate medical/legal documentation is contained in patient records.
- Comply with regulations established by third-party payers, including but not limited to notices of non-coverage reinstatement and continued stay.
- Collaborate with the healthcare team in implementing strategies to reduce length of stay/resource consumption to optimize patient health status for assigned service patients.
- Assess educational needs and provide learning opportunities for healthcare professionals relevant to particular cases and selected patient care groups.
- Collaborate with case management leadership to compile and report aggregate variances and data for specific patient care services.
- Communicate and analyze aggregate variances with members of the healthcare team and develop strategies for variance reduction.
- Registered nurse with a current license.
- Bachelor's degree preferred.
- Minimum of three years clinical experience in an assigned service.
- Recent experience in case management, utilization management, and/or discharge planning/home care in a high-volume, acute care hospital preferred. PRI and Case Management certification preferred.
- Demonstrates effective communication, facilitation, and organizational skills.
- Assertive and creative in problem-solving, critical thinking skills, systems planning, and patient care management.
- Self-directed with the ability to adapt in a changing environment.
- Basic knowledge of computer systems with skills applicable to utilization review process.
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