RN Case Manager

3 weeks 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 strive to provide the best possible care for our patients. As a RN Case Manager, you will play a vital role in ensuring that our patients receive timely and cost-effective care.

As a member of our team, you will work closely with physicians and other healthcare professionals to coordinate care and facilitate discharge plans. You will also promote efficient and effective service delivery through enhanced communication and coordination of the patient-specific plan of care.

Key Responsibilities:

  • Perform assessment and reassessment based on clinical indicators and anticipated services for appropriate level of hospital care
  • Meet with family and healthcare team to assess diagnosis, care needs, and discharge plans
  • Introduce Nurse Case Management (NCM) role to family and complete NCM assessment and document in progress note
  • Provide education to family related to assessment, available resources, and plan of care
  • Develop plan of care with family and healthcare team
  • Act as a resource to healthcare team regarding patient-specific plan 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 provide appropriate interventions
  • Monitor and evaluate patient status
  • Ensure patient-specific plan of care is met based on input from family and adjusts goals and interventions as needed
  • Communicate plan of care and discharge plan with patient/family, healthcare team, home care liaison, and community providers
  • Identify primary care physician (PCP); work with parent/caregivers to identify a PCP if not already aligned with a clinical practice/medical home
  • Negotiate with third-party payors regarding appropriate home care needs when necessary
  • Utilize evidence-based guidelines to anticipate length of stay (LOS) and assist in managing avoidable days
  • Ensure documentation meets department guidelines, standards, and policies
  • Work 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
  • Act as a resource to healthcare team regarding patient-specific plan of care
  • Provide leadership to care team to accomplish outcomes
  • Participate in multidisciplinary care conferences for patient/family in order to facilitate plan of care progress
  • Analyze variances from plan and dispatch departmental and educational resources, communicating anticipated timeframes and working across departments to prevent or resolve delays in service
  • Coordinate with healthcare team to identify and implement appropriate discharge plans incorporating opportunities for alternative care when appropriate
  • Conduct follow-up calls to patient/caregivers to identify any barriers to accessing healthcare or resources, educational needs, and adherence to plan of care
  • Coordinate scheduled transfer and transport to alternative levels of care when appropriate, to include authorizations for service and Preadmission Screening and Resident Reviews (PASSRs)
  • Monitor/evaluate utilization and re-admission data and participate in multidisciplinary councils to address performance improvement and processes
  • Communicate and collaborate with Utilization Management (UM) Nurse, or other NCMs as necessary to provide information relating to plan of care, regulatory requirements, payer issues, and benefits management
  • Understand NCM and UM Nurse role in revenue cycle management
  • Collaborate with UM Nurse to identify and document Avoidable Days according to department processes, as applicable
  • Utilize level of care screening criteria to assist with appropriate level of care assignment and placement, as applicable
  • Monitor system to report case management outcomes and works as a change agent in the resolution of systems issues
  • Identify opportunities for optimizing care delivery
  • Participate in Shared Governance
  • Provide 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

Required 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 Excel

Previous EPIC experience preferred

Licenses and Certifications:

Current and valid Nebraska RN license/RN Compact license

Current and valid Basic Life Support (BLS) through the American Heart Association

Certification from a nationally recognized case management organization

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