Clinical Case Manager
4 weeks ago
We are seeking a skilled Clinical Case Manager to join our team at Waterbury Hospital. The successful candidate will provide clinically-based case management to support the delivery of effective and efficient patient care.
Key Responsibilities- Collaborate with healthcare team members to identify appropriate utilization of resources and ensure reimbursement.
- Review appropriateness of testing and procedures, and make recommendations based on assessment findings.
- Participate in hospital initiatives and projects as identified.
- Assess for the appropriateness of diagnostic testing, procedures, and consults.
- Discuss alternative options with providers if not medically appropriate at inpatient or observation level of care.
- Daily review and reporting on patients in observation level of care.
- Utilize clinical guidelines as appropriate to assist with level of care determination.
- Follow up with providers when discrepancy in level of care is found.
- Analyze peer to peer data and provide feedback to the leadership team.
- Superuser/content expert for Allscripts.
- Collaborate with physicians and interdisciplinary team members to utilize appropriate testing during hospitalization.
- Assist with coordinating and scheduling outpatient testing as appropriate.
- Communicate and coordinate with the healthcare team to intervene when progression is stalled or diverted.
- Complete the interventions necessary for discharges to home with self-care, home with services, and short-term skilled nursing facility placement.
- Actively contribute to, participate in, and follow through on interventions identified in care coordination and complex patient rounds.
- Assess the patient and family for continuing care needs to develop, implement, and evaluate an effective discharge plan in collaboration with the multidisciplinary team.
- Provide support for new projects and hospital initiatives.
- Develop training guides and metric tools for the case management team.
Requirements:
- Graduate nursing program (Diploma/Associates) BSN preferred or actively working towards BSN.
- Minimum of 5 years of broad clinical experience, predominately in medical/surgical nursing.
- Case Management, discharge planning, and utilization review experience preferred.
Preferred Qualifications:
- Ability to problem solve in a proactive, creative manner using sound judgment based on factual information and clinical knowledge.
- Ability to form positive, collaborative relationships with hospital staff, patients, and families.
- Ability to effectively negotiate with internal and external providers of patient care services.
- Basic knowledge of computers and clinical applications.
- Basic knowledge of Microsoft Office, including Excel and PowerPoint.
Waterbury Hospital is an equal opportunity employer and welcomes applications from diverse candidates.
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