Healthcare Case Manager for Montana Hospital

5 days ago

Helena, Montana, United States The Staff Pad Full time
Job Overview:
The Staff Pad is proud to partner with a prestigious non-profit healthcare system in Helena, Montana, renowned for its exceptional care and commitment to the community. We are seeking a highly skilled RN Care Manager to join their esteemed team.

About the Role:
In collaboration with patients, families, physicians, and interdisciplinary teams, the RN Care Manager facilitates efficient and cost-effective patient progress through the Emergency Room and acute episode of care. Key responsibilities include ensuring and monitoring the level of care from ED to discharge, initiating evidence-based protocols, influencing care progression, facilitating patient navigation, and proposing transition plans within 24 hours of admission. The RN Care Manager serves as an advocate for patients and families throughout the ED experience and/or entire acute episode of care.

Key Responsibilities:
• Collaborate real-time with medical staff to ensure correct admission status and confirm treatment goals, treatment plans, and clinical milestones used to advance the treatment plan.
• Meet with patients and families, observe clinical status, and communicate with healthcare teams to assess and document patient navigation and transition needs.
• Identify potential financial barriers to care progression and make referrals to Social Workers, Counselors, or financial counselors as needed to swiftly resolve issues.
• Using pre-determined high-risk screens, identify selected patients with potential transition challenges and assign them to Social Worker Counselors for focused management.
• Confirm admission diagnoses and correct admission statuses, identifying related quality measures to promote medical compliance.

Progression of Care:
• Collaborate with admitting physicians, ED physicians, Hospitalists, Documentation Specialists, and ancillary staff to assist with initial patient assessments and high-risk screenings for resource management.
• Promote adherence to clinical protocols through collaboration with physicians and interdisciplinary teams to encourage evidence-based interventions relevant to patient reasons for admission and immediate acute care needs.
• Provide point-of-care coaching to medical staff on documentation improvement and observance of safety and quality indicators to support admission statuses and care plans.
• Initiate referrals in collaboration with nursing staff for home health, hospice, DME, rehab, etc., and align patient needs with placement options consistent with desired quality targets and patient financial resources.
• Consult with Medical Advisors as necessary to resolve barriers through appropriate administrative and medical channels.
• Demonstrate proactive communication to influence treatment plans and care progression while advocating on behalf of patients and organizational stakeholders.
• Attend daily Hospitalist/staffing meetings and promote the CM/UR RN role as an adjunct to the team's clinical expertise.

Identifying Complex Needs:
• Identify patients/families with complex psychosocial or continuing care needs that may present obstacles for safe transitions to lower levels of care or discharge to the community and make referrals to Social Worker Counselors.
• Facilitate patient movement to alternate levels of care within the hospital through collaboration with patients/families, physicians, and interdisciplinary teams and take responsibility for moving patients to Swing Bed status as appropriate.
• If the CM/UR RN cannot follow the patient through the entire episode of care, directly communicate patient plans of care, progression of care barriers, and probable transition needs to receiving case managers to follow on a daily basis.

Performance Expectations:
• Function as a member of a self-directed Care Management work team, ensuring appropriate coverage based on departmental and population needs served.
• Demonstrate competence to perform all areas included in the Care Management/UR RN job role, including daily assignments such as evaluating patient statuses and needs for acute care services using InterQual severity of illness/intensity of service criteria, communicating daily with other RN CM/UR staff on patient statuses, and working closely with ED physicians and staff to assure patients who are not admitted receive appropriate outpatient referrals and follow-up.
• Participate in performance improvement activities as defined in the departmental plan.
• Prepare monthly updates of work accomplishments using objective data, incorporating them into the department's quality report card.
• Work harmoniously and collaboratively with all personnel within the department and throughout St Peter's Hospital.
• Ability to use electronic software applications related to case management activities, operate copying machines, fax machines, and computers, handle AV equipment, materials, supplies, and patient belongings, and rotate with other CM/UR RNs to provide weekend and holiday coverage for discharge planning and utilization review oversight.

Requirements:
• Minimum of 3-5 years of acute care experience.

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