Pediatric Case Manager

3 hours ago

Omaha, Nebraska, United States Children's Hospital & Medical Center Full time
Job Description

Schedule:

Monday to Friday, no weekends or holidays

At Children's Hospital & Medical Center, we are committed to providing the highest quality care to our patients and their families. As a Pediatric Case Manager, you will play a critical role in ensuring that our patients receive the best possible care.

About the Role:

This is a challenging and rewarding role that requires strong communication and organizational skills. As a Pediatric Case Manager, you will work closely with our healthcare team to coordinate care and facilitate a discharge plan of care. You will also promote efficient and effective service delivery through enhanced communication and coordination of the patient-specific plan of care.

Responsibilities:

  • Perform assessment/reassessment based on clinical indicators and anticipated services for appropriate level of hospital care considering safety, quality, and cost.
  • Meet with the family and healthcare team to assess for diagnosis, care needs, and discharge plans.
  • Introduce Nurse Case Management (NCM) role to family.
  • Complete NCM assessment and document in progress note.
  • Provide education to the family related to the assessment, available resources, and plan of care.
  • Develop plan of care with the family and healthcare team.
  • Act as a resource to the healthcare team regarding patient-specific plan of care to include discharge needs or alternative levels of care.
  • Ensure and provide handoffs to internal and external healthcare providers, personnel, and/or community agencies to coordinate services and assist with continuity of care.
  • Develop action plan in collaboration with family, physician, healthcare team, and third-party payers, as applicable.
  • Meet regularly with patient/family, developing a supportive relationship.
  • Ensure communication with interdisciplinary team and works to remove barriers from accessing appropriate healthcare resources and appropriate level of care.
  • Reassess needs and provides appropriate interventions. Monitors and evaluates patient status.
  • Ensures patient-specific plan of care is met based on the input from the family and adjusts goals and interventions as needed.
  • Communicates plan of care and discharge plan with patient/family, healthcare team, home care liaison, and community providers.
  • Identifies primary care physician (PCP); works with parent/caregivers to identify a PCP if not already aligned with a clinical practice/medical home.
  • Negotiates with third-party payors regarding appropriate home care needs when necessary.
  • Utilizes evidence-based guidelines to anticipate length of stay (LOS) and assists in managing avoidable days.
  • Ensures documentation meets department guidelines, standards, and policies.
  • Works with patient/family to assess needs related to diagnoses, care, and discharge plans, and to help establish expectations of care delivery with family, ensuring that they are actively involved or represented in the plan of care.
  • Acts as a resource to the healthcare team regarding the patient-specific plan of care. Provides leadership to the care team to accomplish outcomes.
  • Participates in multidisciplinary care conferences for the patient/family in order to facilitate plan of care progress.
  • Analyzes variances from the plan and dispatches departmental and educational resources, communicating anticipated timeframes and working across departments to prevent or resolve delays in service.
  • Coordinates with the healthcare team to identify and implement appropriate discharge plans incorporating opportunities for alternative care when appropriate.
  • Conducts follow-up calls to patient/caregivers to identify any barriers to accessing healthcare or resources, educational needs, and adherence to plan of care.
  • Coordinates scheduled transfer and transport to alternative levels of care when appropriate, to include authorizations for service and Preadmission Screening and Resident Reviews (PASSRs).
  • Monitors/evaluates utilization and re-admission data and participates in multidisciplinary councils to address performance improvement and processes.
  • Communicates and collaborates with the Utilization Management (UM) Nurse, or other NCMs as necessary to provide information relating to the plan of care, regulatory requirements, payer issues, and benefits management.
  • Understands the NCM and UM Nurse role in revenue cycle management.
  • Collaborates with the UM Nurse to identify and document Avoidable Days according to department processes, as applicable.
  • Utilizes level of care screening criteria to assist with appropriate level of care assignment and placement, as applicable.
  • Monitors system to report case management outcomes and works as a change agent in the resolution of systems issues.
  • Identifies opportunities for optimizing care delivery.
  • Participates in Shared Governance.
  • Provides educational consults, programs, and presentations internally and externally as needed.

Education Qualifications:

Bachelor's Degree from an accredited college or university in nursing

Experience Qualifications:

Minimum 5 years in nursing required, preferably in a pediatric setting

Skills and Abilities:

Demonstrates written and verbal communication skills. Ability to apply the nursing process to acute patient care to achieve outcomes. Current knowledge of the healthcare environment, including community resources and financial systems. Working knowledge of basic computer programs such as Word and eEcel. Previous EPIC experience preferred.

Licenses and Certifications:

Current and valid Nebraska RN license/RN Compact license Upon Hire Required and Current and valid Basic Life Support (BLS) through the American Heart Association Upon Hire Preferred and Certification from a nationally recognized case management organization Upon Hire Preferred

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