Job Description

$10,000 Sign on Bonus for qualified Case Managers!

MAIN FUNCTION:

The Case Manager coordinates, negotiates, procures services resources for and manages the care of complex patients to facilitate achievement of quality and cost, patient outcomes. The Case Manager works collaboratively with interdisciplinary staff internal and external to the organization. The Case Manager participates in quality improvement and evaluation processes related to the management of patient care. The Case Manager will review all patients for utilization management and appropriate discharge planning. The Case Manager's average caseload will be 1:15-25. The Case Manager that is BSN prepared will be a leader in the Case Management practice. The Case Manager will work cooperatively with the Physician Advisor and Team.

DUTIES AND RESPONSIBILITIES:

** 1. Determines medical necessity and appropriateness of admission and stay in accordance with Interqual.

** 2. Prepares Medicare/Non Medicare hospital notices of noncoverage (HINN) when patient's level of care is no longer covered according to the guidelines.

** 3. Identifies the appropriate patients for Case Management services.

** 4. Maintains a working knowledge of the requirements of 3rd party payers most frequently involved with their caseload population.

** 5. Maintains a working knowledge of the resources available in the community.

** 6. Communicates, collaborates, coordinates and negotiates with physicians, other members of the team, the patients payers and administrators to assess the needs and provide a plan of care for their caseload population.

** 7. In conjunction with the patient/family, other members of the health care team, the payer, and available resources, formulates a plan to address assessed needs and issues, implements the plan, evaluates the effectiveness of the plan in meeting established care goals and revises the plan as needed to reflect the changing needs, issues and goal.

** 8. Evaluates the effects of Case Management on target populations.

** 9. Explores and facilitates strategies to reduce length of stay and resource consumption within case managed populations, implements these strategies and documents the results.

** 10. Manages each patient's transitions through the Health Care system.

** 11. Maintains appropriate documentation of the patient care and progress.

** 12. Identifies the need, arranges for and conducts health care team meetings when necessary to facilitate the coordination of services and resources in complex situations.

** 13. Educates, health team colleagues about case management, including the role and the unique needs of case managed patient population.

** 14. As a member of the Case Management practice:

a. Seeks and provides peer consultation about cases presenting problems and/or experiencing significant deviation from the plan of care. b. Consistently attends daily care rounds and participates in them. c. Facilitates and participates in programs of care meetings related to the appropriate case managed population. d. Manages the appropriate collaborative care plans related to case managed population including and monitoring appropriate placement. e. Arranges for and participates in coverage during long, short, and unexpected absence of self and other case managers. f. The Case Manager tracks and trends LOS, resource utilization, outliers, readmissions, denials, delay days and satisfaction of the case managed population. g. Consistently attends case management staff development meetings. h. Maintains a close working relationship with physicians managing the care of their caseload population. i. Is a resource person for the education of the case management team. j. Identifies areas of knowledge deficit in our system and takes measures to reduce that deficit.

** 15. Coordinates patient discharge and transfers based on the patients need and available resources.

** 16. Coordinates services, i.e. home help, DME etc, based on patient need and resources available.

** 17. Acts as a resource to the team regarding insurance benefits, managed care processes, and utilization issues.

** 18. Is responsible for attending all annual mandatory educational programs as required by position.

19. Employee understands and demonstrates the importance of satisfying the needs of the customer/patient by interacting with him/her in a friendly and caring way, being attentive to the customer’s needs, both psychologically and physically, and by taking the initiative to maintain communication with the customer in order to provide a secure and pleasant experience with the Medical Center.

20. It is understood that this job description lists typical duties for the classification and is not to be considered inclusive of all duties that may be assigned.

MEETINGS:

Case management staff meeting. Case management staff development meetings. Programs of care.

EDUCATION:

Graduate of an approved registered nursing program with a current license as a registered nurse. BSN or Case Management Certification preferred.

EXPERIENCE:

Three years clinical nursing in acute care hospital setting or two years utilization management in an acute care hospital setting. Case management experience preferred but not required.

CARDIOPULMONARY RESUSCITATION (CPR) REQUIREMENTS:

Basic Life Support (BLS) preferred.

PHYSICAL DEMANDS:

Light physical effort. Routine office job.

EXPOSURE CATEGORY:

CategoryI. Tasks that involve exposure to blood, body fluids, or tissues.

** A.D.A. Essential Functions

Requirements