RN, Inpatient Case Manager, On-Call, Emory Decatur

3 weeks ago

Decatur, Illinois, United States Kaiser Permanente Full time
Job Summary

As an Inpatient Case Manager, RN, you will work collaboratively with physician partners to optimize quality and efficiency of care for hospitalized members. Your responsibilities will include daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care, developing a safe discharge plan to include recommending alternative levels and sites of care when appropriate.

Key Responsibilities
  • Plan, develop, assess, and evaluate care provided to members.
  • Collaborate with physicians, other members of the multidisciplinary healthcare team, and patient/family in the development, implementation, and documentation of appropriate, individualized plans of care to ensure continuity, quality, and appropriate resource use.
  • Review, monitor, evaluate, and coordinate the patient's hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
  • Communicate via huddles with hospitalist partner multiple times throughout the day.
  • Review all new inpatient admissions within 24 hours and begin the discharge planning process immediately.
  • Assess high-risk patients in need of post-hospital care planning.
  • Develop and coordinate the implementation of a discharge plan to meet each patient's identified needs; communicate the plan to physicians, patient, family/caregivers, staff, and appropriate community agencies to enhance the effect of a seamless transition from one level of care to another across the continuum.
  • Ensure that the appropriate level of care is being delivered in the most appropriate setting.
  • Recommend alternative levels of care and ensure compliance with federal, state, and local requirements.
  • Perform psychosocial assessments on all patients that meet the high-risk indicators for discharge planning.
  • Comprehensively assess patients' goals as well as their biophysical, psychosocial, environmental, economic/financial, and discharge planning needs.
  • Provide patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness.
  • Refer patients to the ambulatory case managers, care managers, and/or social workers as appropriate.
  • Document all admissions and discharges in the patients' Kaiser Permanente electronic medical record.
  • Make post-discharge follow-up calls to all patients who are not referred to an ambulatory case/care management program.
  • Attend scheduled rounds 2 times/week with the Physician Director of Resource Stewardship to discuss clinical course and discharge planning for assigned patients, identifying any real or potential delays in care or quality of care issues.
  • Act as a liaison between inpatient facility and referral facilities/agencies and provide case management to patients referred, serving as an advocate for patients and families.
  • Coordinate transfer of patients to appropriate facilities; maintain and provide required documentation.
  • Build highly effective working relationships with physicians, SNF staff, vendors, and other departments within the health plan.
Requirements
  • Minimum two (2) years of RN experience in patient care delivery or completion of Masters degree in Case Management Program in lieu of minimum years of experience.
  • Associates Degree Nursing.
  • Registered Professional Nurse License (Georgia).
  • Demonstrated advanced communication and interpersonal skills with all levels of internal & external customers, including but not limited to medical staff, patients and families, clinical personnel, support and technical staff, outside agencies, and members of the community.
  • Ability to collaborate effectively with multidisciplinary healthcare team.
  • Excellent time management skills with the ability to work successfully in a fast-paced environment.
  • Functional knowledge of computers.
  • Experience with managed health care delivery including Medicare.
  • Experience in a payer environment highly desirable.
  • Knowledge of funding, resources, services, clinical standards, and outcomes is preferred.
  • Complex Case Management Certification preferred.
  • Knowledge of the Nurse Practice Act, TJC, DMHC, CMS, NCQA, HIPPA, ERISA, EMTALA & all other applicable federal/state/local laws & regulations.
  • Demonstrated strong communication and customer service skills, problem-solving, critical thinking, & clinical judgment abilities.
  • Fundamental word processing & computer navigation skills & the ability to interpret & use analytic data in day-to-day operations.
  • Knowledge of healthcare benefits associated with various business lines.

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