Case Manager
1 week ago
Facilitates the care of patients to ensure quality outcomes and appropriate utilization of health care resources. The CM works in collaboration with a multi-disciplinary team in the planning, implementation and evaluation of medical and nursing care. Is a key member of a multi-disciplinary team whose primary objective is to care coordination close gaps in care. Performs all job duties and responsibilities in a courteous and customer-focused manner.
Schedule: Monday through Friday, 8 AM to 4PM. Two weekends per month required. Rotating Holidays also required.
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1.Works in conjunction with assigned social worker/case manager coordinating complex patient care throughout the continuum of care among the interdisciplinary team for identified population with a focus on complex LOS issues, readmission and high utilizers of the ED.
2.Provides ongoing assessment and case management of identified patient population to ensure an accurate evaluation of patient needs, appropriate level of care, proper resource utilization, and quality of care and risk management in post-acute setting. Develops goals for patient outcomes based on assessment within identified time and documents in clinical records as indicated with the assigned Case Manager.
3.Monitors and evaluate the plan of care on an ongoing basis and revises goals as needed.
4.Assures compliance with utilization requirements relative to all payer types and contract requirements in post-acute settings in identified population. Assures compliance with federal, state and local requirements e.g. ADA, Workman’s Compensation, EMTALA.
5.In coordination with social work/case management maintains ongoing communication regarding patient care with physicians, referral sources, caregivers, patients, etc. to facilitate, coordinate, and transition of care. Communication is effective and clear while following identified population in post-acute setting.
6.Independently initiates assessments of situations, identifies and explores alternatives and chooses appropriate course of action in areas within scope of practice.
7.Acts as an advocate for individual’s health care needs. Identifies barriers and advocates for patient to access to care. Identifies system problems within the acute care system as well as the community which are barriers to timely care.
8.Establishes communication system with payers to determine benefit eligibility. Maintains knowledge of payer requirements.
9.Responsible for maintaining a professional relationship with referral sources and community resources and participating in local professional organizations and activities.
10.May conduct visits in the field, home, skilled nursing facility, doctor’s office, etc. when needed to assess and/or evaluate patient’s needs or environment of care.
11.Provides patients and families support and information about their current disability.
12.Provides education and support to hospital staff regarding community resources, managed care issues, or payment/ payer issues.
13.Responsible for maintaining a professional relationship with referral sources and community resources, and participating in local professional organizations and activities.
14.Demonstrates an ability to be flexible, organized and functional under stressful situations. Utilizes critical thinking skills and sound judgment in priority setting and delegation.
15.Practices autonomously, consistent with evidenced-based standards. Pursues personal and professional growth and development.
16.Performs other related duties as assigned or requested in order to maintain a high level of service.
Registered Nurse licensed in the state of Connecticut is required.
Minmium of 5 years of strong clinical experience in an acute care setting. Additional experience in home care, long term care and case management is preferred. Professional certification in case management or clinical specialty is highly desirable.
Strong organizational and communication skills are essential.
Completes required department and organization training and education in a timely manner.
Demonstrates professional work behavior by following Service Standards and Success factors.
Complies with departmental organizational policies and procedures and adheres to external agency requirements.
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