Case Management Special Programs

SUMMARY:

The Case Management Special Programs - Case Manager reports to the Manager of Case Management Care Navigation or Director of Case Management. Provides coordinated care support to the Surgical Services, Total Joint Center, Case Management, and the Clinical Manager(s) of respective services across the Brown University Health system. The Case Management Special Programs - Case Manager reviews patients for potential post-acute needs, conducts interview prior to their scheduled surgery, and assists with coordination of care at the various hospitals throughout Brown University Health.

Collaborates with the clinical healthcare team across the patient care continuum to include pre-operative service coordination and post hospital discharge follow-up. Participates in the oversight of the progress of a specific patient population. Collects data and facilitates clinical quality improvement (CQI) teams to enhance the quality and cost effectiveness of patient care and prevent readmissions.

RESPONSIBILITES:

Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these guide our everyday actions with patients, customers and one another.

The Surgical Services Case Manager will work collaboratively with the surgical teams and case management to provide continuity in patient care and improved patient outcomes.

Collaborates with Surgeons' offices to determine patient needs and home safety.

Completes initial patient assessment prior to patients' scheduled procedures.

Partners with medical staff and other members of the healthcare team in collaboration with the patient/family to facilitate the plan of care for a defined patient population across the continuum of care, including post hospitalization.

Proactively builds post-hospital referrals and coordinates post-acute services prior to surgery.

Delivers Important Message follow-up notices to all Medicare patients according to Centers to Medicare & Medicaid Services (CMS) regulations.

Collaborates with members of the patient's healthcare team to evaluate and facilitate development and implementation of the discharge planning process. Develops the initial patient discharge plan and reviews with patient, family members and other members of the interdisciplinary team as appropriate.

Provides care plan direction for the advancement of a patient care delivery system which supports managed care strategies and decreases readmission risk. Acts as a change agent by identifying opportunities to improve patient flow and reduce service delays through problem resolution and follow-up.

Promotes patient satisfaction by facilitating patient participation in education programs and post discharge services as necessary.

Individual Case Managers may be cross-trained to various programs within the Case Management Special Programs Department including Surgical Services Case Manager, Transfer and Access Case Manager, and Outpatient High Risk Case Manager.

Performs other duties as assigned.

Licensure as Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nursing or licensure as a Registered Nurse in accordance with the Nurse Licensure Compact agreement of the National Council of State Boards of Nursing.

Education

Bachelor's Degree in Nursing from an accredited National League of Nursing (NLN) program with current license to practice as a Registered Nurse in the State of Rhode Island is required.

Certification by a recognized national organization in case management is preferred.

Experience

Three to five years of clinical/case management experience, preferably in the acute and/or community setting with an emphasis on populations to be served and in utilization management.

Demonstrated knowledge and skills necessary to provide patient care and to develop or administer care management services with consideration of stages of human development and cultural patterns.

Analytical skills necessary to evaluate patients, programs, and procedures.

Demonstrated ability to exercise independent judgement. Refers specific complex problems to Manager of Case Management or designee, where clarification of departmental policies and procedures may be required.

Interpersonal skills necessary to establish and maintain effective working relationships and to coordinate case management activities in the clinical area.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS

Works in a normal office environment with exposure to patient care.

Must be able to lift and carry ten pounds, when transferring materials throughout the facility.

General hospital environment with occasional stressful conditions associated with patient care.

Risk of exposure to blood borne pathogens and communicable disease is minimized and controlled by adherence to Hospital Infection Control policy and procedures.

Must be able to make hospital rounds through various patient care areas either by walking or through some other mobile means.

Visual acuity and finger dexterity is needed to review medical records, navigate through automated system screens and type on a typical computer terminal keyboard.

Must be able to lift and or carry up to 10 lbs. in order to transport items from one patient care unit to the next.

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EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

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