RN Case Manager

2 weeks ago

Knoxville, Tennessee, United States Covenant Health (Tennessee) Full time
Job Title: RN Case Manager (Non-Certified)

Job Summary:

The RN Case Manager (Non-Certified) is a vital member of our multidisciplinary team, responsible for providing expert clinical practice and coordinating education for staff and patients. This role serves as a clinical resource and consultant to the healthcare team, promoting patient care continuity and quality through the development of practice guidelines and clinical pathways.

Responsibilities:

  • Utilize case finding criteria to screen patients and gather information from medical records, physician documentation, and patient/family communication to develop a comprehensive plan for patient care.
  • Assess and periodically reassess patient progress towards established goals, modifying the case management plan as needed to meet changing patient needs.
  • Collaborate with physicians and other healthcare team members to plan and implement patient care, documenting communication results and direction in the patient's medical record.
  • Communicate effectively with physician offices, home health agencies, rehabilitation facilities, long-term care facilities, and third-party payers to identify goals and ensure timely, efficient, and cost-effective services.
  • Execute and document case management activities and interventions related to specific patient goals, serving as a liaison to provide communication with patients, families, physicians, and the healthcare team.
  • Coordinate, organize, secure, integrate, modify, and document resources needed to accomplish goals related to the case management discharge plan.
  • Identify and communicate variances in patient care processes to the appropriate healthcare team members.
  • Evaluate the case management plan and modify or change the plan as needed to meet patient needs.
  • Utilize statistical analysis techniques to measure clinical and fiscal variances from established patient care guidelines, care designs, protocols, and core measures.
  • Develop reporting mechanisms to communicate outcomes to physicians and other healthcare team members.
  • Support cost containment efforts through the recommendation of performance improvement opportunities by the healthcare team.
  • Maintain ongoing fiscal awareness by communicating outcomes quarterly to the team.
  • Monitor and address outcome variances concurrently.
  • Identify causes of outcome variances and implement actions to improve variances; evaluate corrective actions for improvement.
  • Seek the most efficient, cost-effective ways to provide appropriate care.
  • Conduct research to identify 'best' practices for achieving patient outcomes.
  • Address end-of-life issues as they arise with the physician, family, and other healthcare team members.
  • Maintain patient privacy information with other facilities, services, and departments involved in interdisciplinary discharge planning rounds.
  • Provide case management services maintaining the patient's right to privacy and confidentiality, adhering to Covenant Health's HIPAA policy.
  • Serve as patient advocate in performing case management duties.
  • Provide case management services within the scope of practice as a registered nurse, meeting all required standards both legal and regulatory.
  • Assist with planning, developing, and presenting educational materials designed to foster the patient's and family's understanding of the plan of care.
  • Participate in staff development, orientation, and unit meetings through mentoring, consultation, educational presentations, and clinical direction.
  • Assist with the hiring, supervision, education, orientation, evaluation, and disciplining of staff.
  • Follow policies, procedures, and safety standards. Complete required education assignments annually. Work toward achieving goals and objectives, and participate in quality improvement initiatives as requested.
  • Perform other duties as assigned.

Qualifications:

Minimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below-indicated license and/or certification as required by the issuing authority.

Minimum Experience: Two (2) years of acute care nursing experience; a minimum of two (2) years of experience in assigned area of responsibility.

Licensure Requirements: Must have and maintain Tennessee State RN License.

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